Joyful Together® Interest Sign-Up - OhioGuidestone Research Portal

Electronic Agreement *

By checking this box, I agree to use electronic records and electronic signatures.

Parent/Guardian Name *

First

Last

Phone Number *

Email *

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

How many children between 0 months - 10 years old live in your household?

How many children 0-18 months old? *

How do I answer this if I am pregnant? Please include any children who are not born yet in your answer for "How many children 0-18 months old?". For example, if you have a 1 year old and are 5 months pregnant, please put 2 for your answer to this question.

How many children 18-36 months old? *

How many children 3-5 years old? *

How many children 6-10 years old? *

How did you hear about Joyful Together®?

How was this form completed? *

In-Person
By Phone
Online
Mail-In

Acceptance *

I understand that by checking this box and submitting this form, I am giving permission to Research Team members to call, email and/or text me to follow up about my interest in the Joyful Together® study.