Thank you for your interest in the Center for Infant Studies at Stanford!

Please answer the following questions, and we will call you within the next
few weeks to tell you more about our research, and to answer any questions
you may have. The information you provide us here will be used solely for
the purpose of contacting you, and we will keep your name and address on
file ONLY if you have indicated further interest in participating in our
program at the time of our call. All information about families who have
chosen to participate is kept secure and not shared with anyone else.

Baby's Name:

Baby's Birthdate:

Baby's Sex:
Female
Male

Mother's Name:

Father's Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Other Phone:

Email:


Are there any days/times of day that are especially convenient for us to call you?


What languages does your child hear regularly?

How did you hear about us? :
letter from the hospital and/or us
internet advertisement
friends/word-of-mouth
other (please specify below)

Have you (or any of your children) registered with us before?:
Yes
No

Anything else you'd like to ask or tell us?