Register your Family

Currently, we are recruiting children between 0 and 7 years of age from Charlottesville and surrounding areas (currently, our studies extend only through the early elementary ages). If you are interested in bringing your child for a single visit lasting about 30 minutes, please fill in the form below, and click on the “submit” button. We will acknowledge receipt of the form by email within a week, and your family will be added to our database.

If you have already been called about participating in a study, or have already participated in a study in UVa’s Psychology Department, then your child is probably already registered with us. However, if you would like to confirm this, feel free to phone, email, or submit this registration form.

All of your information is completely confidential; it is used only by researchers in developmental psychology at the University of Virginia to inform you about studies in which you may be interested in participating.

Please note: This is not a secure server. If you are concerned about transmitting this information over the internet, you may fax your information to 434-982-4766 (attn: Child Development Labs), email it to us at info@childdevelopmentlabs.org, or phone us at 434-243-5234.

Registration Form:

Child’s name:

Sex:

Date of Birth: (Month/Day/Year)

Mother/Parent: (Full Name)

Father/Parent: (Full Name)

Which parent should we contact? (Name or "either")

Street Address:

City:

Zip:

Home Phone: (including area code)

Work Phone: (including area code)

Email: (full email address)

Contact me...

Was child born full-term?

Has child had any ear infections that might have affected hearing?

Brothers & Sisters: (please give names and birthdays)

Does your child hear any languages other than English on a regular basis (more than 10% of the time)? If so, which ones and estimate percentage, if possible.

How did you hear about us?

Any other comments?