Child Enrollment Form

Below you can sign up your child to participate in one of our studies! If you have more than one child you would like to enroll, please fill out the form once for each child. After you fill out this form, a lab member will email you to confirm your enrollment. The questionnaire below should take around 5 minutes and it is important that you fill it out as completely as possible. All testing takes place at our research lab in room 307 of Jubilee Hall at Seton Hall University on the South Orange campus. It is important to note that the submission of this form does not obligate you to participate in any way nor does it guarantee your child’s placement in our database. Furthermore, all of your information is kept strictly confidential. While participating in any experiment, you may withdraw your child at any time. At the Child Learning Lab, we run participants of specific ages all year round, so it might be some time until you are contacted for a study, but please be patient, we have not forgotten about you! Thank you!

Family Information

Parent/Guardian's Name*

Relationship to Child*

Child's Name*

Child's Gender*

Child's Date of Birth*

Was your child born at full term (40 weeks)?

If not, then how many weeks?

Contact Information

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Email*

Phone*

Type of phone number*

Preferred Contact Method*

How Did You Hear About Our Lab? (ctrl-click to select multiples)

(Other)

For brochure or flyer please indicate the location

* Denotes a required field.