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If you are the parent of children 8 years old or younger, we would like to invite you and your children to participate in studies on child development. It is fun and it is an easy way to contribute to society.

Parents Information
First Name*:
Last Name*:
ZIP Code:
Home Phone:	( ) -
Mobile Phone:	( ) -
E-mail*:
Language Information
Are there other languages spoken at home, other than English?	No   Yes
If yes, what language(s):
How much?	less than 10% 25% 50% (bilingual) 75% 100% (child is not exposed to English)
Child #1
First Name:
Last Name:	Gender Boy Girl
Birth Date:	/ /
Full Term:	No   Yes
Expected Due Date:	/ /
Birth Weight:	lbs oz
Child #2
First Name:
Name:	Gender Boy Girl
Birth Date:	/ /
Full Term:	No   Yes
Expected Due Date:	/ /
Birth Weight:	lbs oz
Child #3
First Name:
Name:	Gender Boy Girl
Birth Date:	/ /
Full Term:	No   Yes
Expected Due Date:	/ /
Birth Weight:	lbs oz
Child #4
First Name:
Name:	Gender Boy Girl
Birth Date:	/ /
Full Term:	No   Yes
Expected Due Date:	/ /
Birth Weight:	lbs oz

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