Informed Assent Form Page 4
Download a blank fillable Informed Assent Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Informed Assent Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Signature of child: ____________________
Date:________________
day/month/year
If illiterate:
A literate witness must sign (if possible, this person should be selected by the participant, not be a
parent, and should have no connection to the research team). Children who are illiterate should
include their thumb print as well.
I have witnessed the accurate reading of the assent form to the potential participant, and the
individual has had the opportunity to ask questions. I confirm that the individual has given
assent freely.
Print name of witness (not a parent)____________ AND
Thumb print of child/ minor
Signature of witness ______________________
Date ________________________
Day/month/year
I have accurately read or witnessed the accurate reading of the assent form to the potential
participant, and the individual has had the opportunity to ask questions. I confirm that the
individual has given assent freely.
Print name of researcher_________________
Signature of researcher___________________
Date__________________
Day/month/year
Copy provided to the participant ________(initialed by researcher/assistant)
Parent/Guardian has signed an informed consent ___Yes
___No
_____(initialed by
researcher/assistant)
Page 4 of 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal