Contribute to science at American University!

Participant Registry Form

Thank you for your interest in our research! This form is for adding your family to our participant registry. If you are part of our participant registry, we will contact you when your child is elligible for studies in our lab. All studies are voluntary and you may alter your information in the registry or remove yourself from the registry at any time by emailing wonder@american.edu.

Name of Infant/Child

First Name

Last Name

Sex

Male
Female

Date of Birth (or expected date of birth)

Birth Weight

Due Date

Was your child born before 36 weeks of gestational age?

Yes
No
Unknown

Is your child regularly spoken to in a language other than English? (More than 50% of the time)

Yes
No

Which language(s)?

From whom?

Does your child have any of the following?

Autism Spectrum Disorder
Anxiety Disorder
Neurological Disorder or Epilepsy
Vision or Hearing Disorder
Language Disorder or Delay
None
Other (please describe)

Race (Optional)

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White or Caucasian

Ethnicity (Optional)

Hispanic or Latino
Not Hispanic or Latino

Would you like to add additional children?

Yes
No