The Australian DCD / Dyspraxia Research Register Registration
The Australian DCD / Dyspraxia Research Register welcomes the registrations of children and adults diagnosed with DCD / Dyspraxia, and their families, who are interested in potential participation in future research projects.

Registering your interest in research will allow us to send you information about future research in which you may like to participate. All information will remain strictly confidential. After registering, your information will be stored on a secure database at Victoria University. It will not be passed on to third parties, nor will it be used in any research.

Details of relevant research projects, approved by an Australian Human Research Ethics Committee, will be forwarded to potentially eligible individuals or families, for consideration to participate.

Please note: Expressing your interest does not commit you to taking part in any research project now or in the future. You may ask to be removed from the database at any time without question.

* Before registering, you should read the ‘Conditions of Expression of Interest’ listed below.

Any questions you have about the Register should be directed to:
Associate Professor Jacqueline Williams
Victoria University
jacqueline.williams@vu.edu.au   
03 9919 4025

Conditions of Expression of Interest
1. You must be the parent / legal guardian of the child whom you are registering or you must be over 18 years of age to register yourself.
2. Registering your interest does not commit you to taking part in any research project now or in the future.
3. You may ask to be removed from the database at any time without question. You may also ask to be removed temporarily if your circumstances mean that you would not like to receive information in the short-term. You can do this by contacting Dr Jacqueline Williams on 03 9919 4025 or jacqueline.williams@vu.edu.au.
4. The information you provide when registering will not be used for any research purposes.
5. The information you provide will be stored on a secured database. It will only be used to a) identify potentially eligible participants for research projects and b) forward research project information to those potentially eligible.
6. All information you provide when registering will be kept confidential and will not be used for any other purpose than that described in point 5. It will not be on sold to third parties or used for marketing purposes.
7. You are not required to provide information regarding date of birth or gender, however, doing so will enable us to exclude you from receiving information about studies that you are not eligible to participate in.


Sign in to Google to save your progress. Learn more
Registration details
Please complete the following information to register your details.
I have read the ‘Conditions of Registration’ and agree to the following information being used under the conditions described. *
Required
I am over 18 years of age and I am registering myself or a child of which I am the parent or legal guardian. *
Required
I am registering: *
The following information is specific to the individual specified in the previous question (either yourself or your child)
This information is optional. You are not required to provide it but doing so will ensure we send the most relevant study information to you.
Date of birth of registered individual (either yourself or your child)
MM
/
DD
/
YYYY
Gender of registered individual (either yourself or your child)
My contact details
Please enter the contact details of the person who should receive the information about research studies (this should be a parent or guardian if the registered individual is under the age of 18). Please provide at least one form of contact.
My surname *
My first name *
My title *
I/we live in: *
My email address *
My mailing address (please include suburb and postcode)
Thank you for your interest and support of research into DCD/Dyspraxia.
Don't forget to click SUBMIT!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report