Recruitment Database Registration Parent's Name * First Name Last Name Email * Phone * (###) ### #### How did you hear about us? * Brochure DC Urban Moms and Dads (DCUM) Facebook Flyer (On-campus) Flyer (Off-campus) Mailing Mason Working Moms Listserv Received Call/Voicemail Received Email Word of Mouth (Friend, Family, Other) I Don't Remember --Other If 'Other' above, please tell us below: Please select the option below that most aligns with your interest. * Note: in-person research is completely halted at this time because of COVID-19, but please indicate if you would be willing to participate in-person once things are safe again. I am local and interested in participating in both IN-PERSON and ONLINE study opportunities. I am interested in ONLINE opportunities only. Child's Information Child's First Name * Child's Age * Is your child's primary language English? * Yes No If you answered no to the previous question, what is your child's primary language? Does your child have siblings? Yes No Sibling Information (Optional) You can register additional children below. Sibling #1's First Name Sibling #1's Age Sibling #2's First Name Sibling #2's Age Sibling #3's First Name Sibling #3's Age Thank you! We have added your family to the database. When we launch a new study that your family is eligible for, we will contact you to give you more information.For now, please check out our current studies to see if there are any of interest.Please note that you can remove your family’s information from the database at any time by emailing us at devminds@gmu.edu.
