Participate

Please fill out this form if you are interested in having your child participate in a study. There is no obligation to participate once you are added to our database.

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:  e.g. (860)685-4887
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: e.g. mm/dd/yyyy
*Gender:

Male
Female

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

Male
Female

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

Male
Female

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

Male
Female

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

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

Zip:

Any questions or comments?

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