The Child Language and Emotion Lab

 

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Thank you for your interest in The Child Language and Emotion Lab!
Please answer the following questions so that we can put you on our list of interested parents.  When your child approaches the age for one of our studies, we'll call to provide you with more information and to see if you'd like to participate.

  


Baby's Name:

Baby's Birthdate:

Baby's Sex:
Female
Male

Mother's Name:

Father's Name:

Street Address:

City:

State:

ZIP:

Home Phone:

Other Phone:


Was your child a full-term baby?
Yes
No
If no, please explain:

Does your child have normal hearing and vision?
Yes
No
If no, please explain:


Names and birthdates of your child's siblings:


Are there any days in the week or times in the day that are better for you?


What languages does your child hear in the home (please estimate percentages of each)?


How did you find out about us?


Anything else you'd like to ask or tell us?