Infant & Child Registry / Research Participation Core

Sign up here to be contacted about upcoming studies on how children learn and develop. If you prefer to sign up by email or phone, feel free to email us at rpc@waisman.wisc.edu, or call us at (608) 263-5192.

Parent / Guardian Information

Parent/Guardian 1:
First and Last Name

Parent/Guardian 2:
First and Last Name

Address:

City:

State: Zip Code:

Phone & Email

Home Phone:

Cell Phone:

E-Mail:

Child / Children

Child 1:
First & Last Name:

Date of birth:

Child 2:
First and Last Name:

Date of birth:

Child 3:
First and Last Name:

Date of birth:

Child 4:
First and Last Name:

Date of birth:

Child 5:
First and Last Name:

Date of birth:

How Did You Find Out About Us?

Information from hospital Birthing Center
Information from hospital education class
I heard about it from a relative, friend or neighbor
Waisman Center research lab
Other:

Links For Families and Individuals

Links For Researchers

Infant & Child Registry On-line Enrollment Form

Infant & Child Registry
On-line Enrollment Form