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Indiana University Bloomington

Child Scientist Sign-Up Form

Only parents or legal guardians should fill out this form. We will contact you within 5 business days. The Department of Psychological and Brain Sciences 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: 03/01/09)
Parent's names:
    Mother:  Last: First:
    Father:  Last: First:
Street address:
City: State: Zip code:
Home phone number:
Work phone number:
Mobile phone number:
Email address:
Has this child previously participated in an experiment
thru the Department of Psychological and Brain Sciences?
     Yes No
Does this child have siblings under 8 years of age
who would also like to participate?
     Yes No
    If yes, please complete additional participation form(s)
    after submitting this one.