by lowering.baylor | Nov 1, 2018 JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.Learning to Talk Lab- Child RegistrationSign in to Google to save your progress. Learn more* Indicates required questionParent/Guardian's First and Last Name *Your answerEmail address *Your answerPhone Number *Your answerWe like to know how families hear about us. How did you hear about us? *(Facebook, a friend, website, Infant and Child Studies Consortium, community event, library, Maryland Day, etc.) Your answerChild's First name *Your answerChild's Date of Birth *MM / DD / YYYYDoes your child communicate with any language besides English on a regular basis?No, my child only communicates in English.Yes, my child communicates in other languages on a regular basis. (Please describe in line below)Other:Clear selectionIf you answered "Yes", please describe below...Your answerDoes your child have a cochlear implant?YesNoClear selectionDo you have any additional questions and/or comments?Your answerIf you would like to sign up more than one child, please add in the additional information below. If you would only like to sign up one child, please scroll to the bottom and click submit.2nd Child's First NameYour answer2nd Child's Date of BirthMM / DD / YYYYDoes your 2nd child communicate with any language besides English on a regular basis?No, my child only communicates in English.Yes, my child communicates in other languages on a regular basis. (Please describe in line below)Other:Clear selectionIf you answered "Yes", please describe below...Your answerDoes your 2nd child have a cochlear implant?YesNoClear selection3rd Child's First NameYour answer3rd Child's Date of BirthMM / DD / YYYYDoes your 3rd child communicate with any language besides English on a regular basis?No, my child only communicates in English.Yes, my child communicates in other languages on a regular basis. (Please describe in line below)Clear selectionIf you answered "Yes", please describe below...Your answerDoes your 3rd child have a cochlear implant?YesNoClear selection4th Child's First NameYour answer4th Child's Date of BirthMM / DD / YYYYDoes your 4th child communicate with any language besides English on a regular basis?No, my child only communicates in English.Yes, my child communicates in other languages on a regular basis. (Please describe in line below)Clear selectionIf you answered "Yes", please describe below...Your answerDoes your 4th child have a cochlear implant?YesNoClear selectionSubmitClear formNever submit passwords through Google Forms.This form was created inside of University of Maryland, College Park. Report Abuse Forms
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