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University of Miami Brain Development Lab Child Participation Form
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* Indicates required question
Child's First Name
*
Your answer
Parent or Guardian's Full Name
*
Your answer
Child's Age
*
Your answer
Child's Gender
*
Female
Male
Child's Handedness
*
Right
Left
Ambidextrous
Has your child been diagnosed with Autism Spectrum Disorder?
*
Yes
No
Email Address
*
Your answer
Phone Number
*
Your answer
Zip Code
*
Your answer
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