Participant'S Consent Form (Page 2 of 2) in pdf

Participant'S Consent Form Page 2

Section B: To be completed by the Participant (or the Participant’s Parent)

(Note: Delete the underlined words before or after “/” so that this form suites your study. On the right,

NA means Not applicable)

Participant’s Declaration:

• I agree to/to have my child take part in the above study.

Yes / No

• I have been advised that the data/content of the interview will be used for research

purposes only.

Yes / No /NA

• I consent to the publication of the study results/the edited interview transcription,

so long as

a) they are presented in a manner that does not identify me/my child, or,

Yes / No /NA

b) I have granted permission to expose my/my child’s identity

Yes / No

c) the edited interview transcript(s) has been reviewed and endorsed by me

Yes / No /NA

• I understand that my/my child’s participation is voluntary and that I am/he/she is

free to withdraw at any time, without giving any reason and without penalty.

Yes / No

• I agree to be/have my child audio/video recorded.

Yes / No

Participant’s Signature: _________________________

Participant’s Name

: _________________________

Date

: _________________________

************************************************************

Participant'S Consent Form Page 2