Sample Informed Consent Form printable pdf download

Sample Informed Consent Form

Instructions to the Student Researcher: An informed consent/assent/permission form should be developed in

consultation with the Adult Sponsor, Designated Supervisor or Qualified Scientist.

This form is used to provide information to the research participant (or parent/guardian) and to document written

informed consent, minor assent, and/or parental permission.

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When written documentation is required, the researcher keeps the original, signed form.

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Students may use this sample form or may copy ALL elements of it into a new document.

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If the form is serving to document parental permission, a copy of any survey or questionnaire must be attached.

Student Researcher:

Title of Project:

I am asking for your voluntary participation in my science fair project. Please read the following

information about the project. If you would like to participate, please sign in the appropriate box below.

Purpose of the project:

If you participate, you will be asked to:

Time required for participation:

Risks:

Benefits:

How confidentiality will be maintained:

If you have any questions about this study, feel free to contact:

Adult Sponsor: __________________________ Phone/email: ________________________________________

Voluntary Participation:

Participation in this study is completely voluntary. If you decide not to participate there will not be any negative

consequences. Please be aware that if you decide to participate, you may stop participating at any time and you

may decide not to answer any specific question.

By signing this form I am attesting that I have read and understand the information above and I freely give my

consent/assent to participate or permission for my child to participate.

Adult Informed Consent or Minor Assent

Date Reviewed & Signed: ____________________________

Printed Name of Research Subject: _________________

Signature: ____________

_____________________________

Parental/Guardian Permission

(if applicable)

Date Reviewed & Signed: _____________________________

Parent/Guardian Printed Name: _________________ Signature: _________________________________________

Regeneron Science Talent Search 2016

Sample Informed Consent Form