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Wilson Genetic Engineering Infant Genetic Determination Form Please choose your child’s gender: [ ] Male [ ] Female [ ] No preference Child’s hair color: [ ] Blonde [ ] Dirty Blonde [ ] Light brown [ ] Auburn [ ] Black [ ] Red [ ] Strawberry blonde [ ] Purple [ ] Turquoise [ ] Tickle Me Pink [ ] Green [ ] No preference Child’s hair texture: [ ] Straight [ ] Curly [ ] Wavy [ ] No preference Child’s eye color: [ ] Blue [ ] Brown [ ] Green [ ] Hazel [ ] Black [ ] White [ ] No Preference

Please determine child’s height: [ ] ______ [ ] No preference Child’s stature tendencies: [ ] Athletic [ ] Scrawny [ ] Obese [ ] No preference Listed are possible health issues/disorders; you must choose at least 6 of the following: [ ] Cancer (the specific type cannot be pre-determined) [ ] Heart disease [ ] Scoliosis [ ] Cerebral Palsy [ ] Down Syndrome [ ] Turner Syndrome (If female) [ ] Klinefelter’s Syndrome (If male) [ ] Cri-du-chat [ ] Multiple Sclerosis [ ] Type 1 Diabetes [ ] Cystic Fibrosis [ ] Mental Retardation [ ] Schizophrenia [ ] Rheumatoid Arthritis [ ] Asthma [ ] Leprosy [ ] Insomnia [ ] Multiple Personality Disorder [ ] Parkinson’s Disease [ ] Acquired Immune Deficiency Syndrome [ ] Attention Deficit Disorder

Child’s race: [ ] White [ ] Black [ ] Indian [ ] Asian [ ] Latin American [ ] Combination-Please determine percentage of each race_______________________________ [ ] No preference

Disclaimer: Wilson Genetic Engineering can NOT guarantee absolute results and is not liable for any possible deviation from your original choices stated on this form that may result from tampering with your infant’s genes.