Department of Education: Region I
Department of Education: Region I
Department of Education
Region I
Introduction
The purpose of this form is to provide you (as the parent of a prospective research
study participant) information that may affect your decision as to whether or not to let
your child participate in this research study. The person performing the research will
describe the study to you and answer all your questions. Read the information below and
ask any questions you might have before deciding whether or not to give your permission
for your child to take part. If you decide to let your child be involved in this study, this
form will be used to record your permission.
This study will take within three-months, twice/thrice a week, one-hour per
session.
How will your child’s privacy and confidentiality be protected if s/he participates in
this research?
Your child’s privacy and the confidentiality of his/her data will be protected
compilation of outputs in their own folders and securely be kept appropriately. Your
child’s research records will not be released without your consent unless required by law
or a court order. The data resulting from your child’s participation may be made available
to other researchers in the future for research purposes not detailed within this consent
Signature
You are making a decision about allowing your child to participate in this ACTION
RESEARCH. Your signature below indicates that you have read the information
provided above and have decided to allow them to participate in the study. If you later
decide that you wish to withdraw your permission for your child to participate in the
study you may discontinue his or her participation at any time. You will be given a
copy of this document.
_________________________________ _________________________________
Printed Name of Child Signature
_________________________________ _________________________________
Printed Name of Parent(s) or Legal Guardian Signature
Date: __________________