{"id":25,"date":"2013-02-15T15:29:34","date_gmt":"2013-02-15T20:29:34","guid":{"rendered":"http:\/\/blogs.shu.edu\/childlab\/?page_id=25"},"modified":"2017-06-16T13:29:10","modified_gmt":"2017-06-16T17:29:10","slug":"enroll","status":"publish","type":"page","link":"https:\/\/blogs.shu.edu\/childlab\/enroll\/","title":{"rendered":"Child Enrollment Form"},"content":{"rendered":"<p>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&#8217;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!<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f109-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"109\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/childlab\/wp-json\/wp\/v2\/pages\/25#wpcf7-f109-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"109\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f109-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h2>Family Information\n<\/h2>\n<p>Parent\/Guardian's Name*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"p-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"p-name\" \/><\/span>\n<\/p>\n<p>Relationship to Child*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"relationship\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"relationship\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Father\">Father<\/option><option value=\"Mother\">Mother<\/option><option value=\"Other\">Other<\/option><\/select><\/span>\n<\/p>\n<p>Child's Name*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"c-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c-name\" \/><\/span>\n<\/p>\n<p>Child's Gender*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><\/select><\/span>\n<\/p>\n<p>Child's Date of Birth*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"dob\" \/><\/span>\n<\/p>\n<p>Was your child born at full term (40 weeks)?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"termYN\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"termYN\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span>\n<\/p>\n<p>If not, then how many weeks?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"no-weeks\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"no-weeks\" \/><\/span>\n<\/p>\n<h2>Contact Information\n<\/h2>\n<p>Address Line 1*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address-1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address-1\" \/><\/span>\n<\/p>\n<p>Address Line 2\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address-2\" \/><\/span>\n<\/p>\n<p>City*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n<\/p>\n<p>State*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"state\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"CT\">CT<\/option><option value=\"NJ\">NJ<\/option><option value=\"NY\">NY<\/option><option value=\"PA\">PA<\/option><\/select><\/span>\n<\/p>\n<p>Zip Code*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"zip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zip\" \/><\/span>\n<\/p>\n<p>Email*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n<\/p>\n<p>Phone*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone\" \/><\/span>\n<\/p>\n<p>Type of phone number*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"type\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Home\">Home<\/option><option value=\"Cell\">Cell<\/option><option value=\"Work\">Work<\/option><\/select><\/span>\n<\/p>\n<p>Preferred Contact Method*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"method\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"method\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Email\">Email<\/option><option value=\"Phone\">Phone<\/option><option value=\"Mail\">Mail<\/option><\/select><\/span>\n<\/p>\n<p>How Did You Hear About Our Lab? (ctrl-click to select multiples)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-221\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" multiple=\"multiple\" name=\"menu-221[]\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Brochure\">Brochure<\/option><option value=\"Facebook\">Facebook<\/option><option value=\"Flyer\">Flyer<\/option><option value=\"Friend\">Friend<\/option><option value=\"Mailing\">Mailing<\/option><option value=\"Recruitment Event\">Recruitment Event<\/option><option value=\"Web Site\">Web Site<\/option><option value=\"Other (please specify below)\">Other (please specify below)<\/option><\/select><\/span>\n<\/p>\n<p>(Other)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other-method\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-method\" \/><\/span>\n<\/p>\n<p>For brochure or flyer please indicate the location\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"where\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"where\" \/><\/span>\n<\/p>\n<p>* Denotes a required field.\n<\/p>\n<h2><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/h2><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"93\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>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 &hellip; <a href=\"https:\/\/blogs.shu.edu\/childlab\/enroll\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-25","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/pages\/25","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/comments?post=25"}],"version-history":[{"count":4,"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/pages\/25\/revisions"}],"predecessor-version":[{"id":743,"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/pages\/25\/revisions\/743"}],"wp:attachment":[{"href":"https:\/\/blogs.shu.edu\/childlab\/wp-json\/wp\/v2\/media?parent=25"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}