Cognitive Development Lab

Participate

Please fill out this form if you would like us to contact you about having your child participate in a study. There is no obligation to participate!

Please note that you must be within commuting distance of the lab at Wesleyan University in Middletown, CT in order to participate in our studies [directions to the lab].

Please enter your information:
*Your First name:
*Your Last name:
Your Phone Number:	(860)454-9900
Best time to call:
Your E-mail:

Please enter your child’s (or children’s) information:
Child’s First name:
Child’s Last name:
Child’s Birthdate:	eg. mm/dd/yyyy
Gender:

Child’s First name:
Child’s Last name:
Child’s Birthdate:	eg. mm/dd/yyyy
Gender:

Child’s First name:
Child’s Last name:
Child’s Birthdate:	eg. mm/dd/yyyy
Gender:

Child’s First name:
Child’s Last name:
Child’s Birthdate:	eg. mm/dd/yyyy
Gender:

Please enter your primary address:
Street Address1:
Street Address2:
City:
State:
Zip:

Any questions or comments?

Thank you for your time. We will be in contact with you as soon as possible.

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Modified on: Jul 10th, 2009 Log in