Experimental subject Registration as a volunteer in the experiment

Research and knowledge allow us to advance as a society.
For this reason, we encourage you to participate in our research as an experimental subject.

Modality in which you would like to intervene (*)

PERSONAL DATA

Name and Surname (*)

Email (*)

Date of Birth (*)

Sexo (*)

Nationality (*)

Level of Education (*)

Spanish Level (*)

English Level (*)

German Level (*)

Other Languages, separated by commas

Nivel de otros idiomas, separados por comas.

MEDICAL DATA

The following data respond to the experimental specificities. They serve as indicative data and experimental screening.

Height in cm (*).

Weight in Kg (*).

Body lateralisation (*)

Vision (Use of glasses or contact lenses) (*)

Type and graduation? .

Existence of visual anomalies (*)

which?

Hearing (Use of hearing aids) (*)

graduation?.

ACurrently taking medications (*)

Indicate the name of the medication(s), separated by commas.

sychiatric/Psychological Diagnoses (Name OF problem)

Allergies (name type)

Medical history to be highlighted

VISUAL DATA

Specific data for Virtual Reality Augmented Reality and Eye tracking

Use of glasses or contact lenses (*)

Strabismus (Use of hearing aids) (*)

Number of Diopters.

Existence of visual abnormalities (*)

Discromatopsia

Typology

Date of last eye check-up

I have read and accept the Privacy Policy.
By sending this questionnaire I give my consent for the University of Las Palmas de Gran Canaria to use my data for experimental evaluation and to contact me via email with the aim of my participation in an experimental design. Likewise, I am informed that the data that I currently send is totally anonymous and that it will be subject to the specific regulations of Organic Law 3/2018, of December 5, on Data Protection and Guarantee of digital rights.