Recruitment Form

Child Information

Male Female

Is the child on any prescription medication? * Yes No
Does the child have any history of mental illness or learning disability? * Yes No

Race/Ethnicity

Caucasian
African American

Asian
Native American

Hispanic
Mixed/Other

Does the child speak more than one language at home? Yes No
    If so, what language(s)?
Preferred method of contact   Phone   E-mail

How did you find out about our lab? *

By submitting this form you are agreeing to the terms outlined within the disclaimer presented here.

* = mandatory