HICCUP for Families

For Families

Sign up for HICCUP

We thank you and your family for your participation. Please follow the next few simple steps. We will ask for simple personal information including your name, date of birth, brief medical history, and contact information.  This information will be kept strictly confidential and carefully protected. (Click here to view Confidentiality and Participation details). You will be asked to provide your informed consent to be part of the HICCUP program and willingness to be contacted by investigators for invitations to participate in specific studies. Participation in HICCUP does not obligate you to participate any actual study. Specific information will be provided and your consent sought by investigators for specific studies.

  • 1
    Review Consent Forms
  • 2
    Add Primary Contact
  • 3
    Add More Family Members
  • 4
    Define Contact Frequency
I confirm that all adults wishing to submit their information for study inclusion have read and agree to the consent form. Click here to view the Parent Consent Form.
Each child member of the family deemed capable by the parents has read and agrees to the Assent form. Click here to view the Child Assent Form.

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.