Registration
Parent / Carer Information
Title: Ms / Miss / Mrs / Mr / Dr / Other (please circle)
Forename:………………………………. Surname:……………………………………....
Contact Address:……………………………………………………………………………...
Town……………………………………………….. Postcode:………………………
Email address:……….………………………………………………………………………..
Home Tel:...... Mobile:......
Child/ren’s Information
Child’s name:…………………… ………………………… DoB:…………….…… M / F
Child’s name:…………………… ………………………… DoB:…………….…… M / F
Child’s name:…………………… ………………………… DoB:…………….…… M / F
Child’s name:…………………… ………………………… DoB:…………….…… M / F
Child’s name:…………………… ………………………… DoB:…………….…… M / F
The questions below are about the primary and secondary carers’ language backgrounds, their jobs, and your child’s development. Your answers will help us to recruit your child to appropriate studies.
Which language(s) do your children hear at home?
………………………………………………………………………………………………….
From primary caregiver: (tick one of the three)
☐ Only English.
☐ English and another language. Which language? ……………………………………
☐ Only the other language. Which language? ……………………………………….….
What is the relationship between this caregiver and the child? …………………………
If this caregiver works outside the home, what job do they do? …………………...……
From secondary caregiver: (tick one of the three)
☐ Only English.
☐ English and another language. Which language? ……………………………………
☐ Only the other language. Which language? ………………………………………….
What is the relationship between this caregiver and the child? …………………………
If this caregiver works outside the home, what job do they do? ………………..……….
Please list any hearing or other developmental impairments. Please specify which of these and for which child.
Please list any language delay diagnosis. Please specify which of these and for which child.
Was your child born more than 6 weeks premature? Yes / No
Would you like to receive our twice-yearly newsletter? Yes / No
How did you hear about us?
☐ LCDU website
☐ LCDU newsletter
☐ Social media
☐ Newspaper
☐ Leaflet (where did you see the leaflet?)
☐ Event
☐ Word of mouth
☐ Other (please specify)…………………………………………………………………
Thank you! We look forward to working with you.
Any information you provide will be used only by us to invite you to take part in our studies. It will be entered into our password-protected database, kept confidential, and will be automatically deleted when your child turns 16. If you would like your data deleted before that point, please email us on ; you don’t have to give a reason. Any paper forms will be destroyed after the data has been transferred to the electronic format described above. By entering your data into any of the forms below, you are agreeing to these terms. If you would like to check or update your record, please get in touch. If you have downloaded in this form from our website, please return it to to Leeds Child Development Unit,Linguistics & Phonetics,University of Leeds,LS2 9JT.