children scientists

Participation Form

Only parents or legal guardians should fill out this form. We will contact you within 5 business days. The IU Cognitive Develoment Lab respects and protects the privacy of the information you submit to us.

Child's full name:
Last: First: Middle Initial:

Please indicate gender: male female

Child's birthdate: (ex: 03/01/00)

Parent's names:
Mother Last: First:

Father Last: First:

Street address:

City: State: (ex: IN) Zip code:

Home phone number: (ex: 812-555-5555)

Cell phone number: (ex: 812-555-5555)

Work phone number: (optional)

E-mail address: (ex:

Is this your child's first visit to the
Cognitive Development Lab?
no yes

Does this child have siblings under 6 years of age
who would also like to participate?
yes no

If yes, please complete additional participation form(s) after submitting this one. Thank you.

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