Parent Guardian Consent Form

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Accent Study
Parent/Guardian Consent form
Child’s Name: ______________________________
D.O.B: ____________
Pre-school your child attends: __________________________________________
Pre-school teacher’s Name: ____________________________________________
I am happy for my child to participate in the study investigating the effect of
accent on the ability of children with speech difficulties to understand sentences
Yes
no
I understand that my child is participating as a child who does not have any speech
or language difficulties
Yes
no
I would like a report summarising my child’s assessment results posted to me
Yes
no
Signed: __________________________
Date: _________________
Name in Block Capitals: ____________________________________________
Contact Number: _________________________________________________
Address: _________________________________________________________
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