Sample Parent Consent Form for a Child by 1k8CX7

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									                             PARENT CONSENT FORM FOR RESEARCH

Informed consent procedures involving children must be designed so that:
-the parent receives a copy of both the child assent form and the parent consent form
        (they may not be combined into a single document because that would defeat
        the purpose of seeking the child’s assent independently)
-written or electronic parent consent is obtained prior to seeking child assent
-the assent form can be read aloud as a “script” before the child’s signature or
        cooperation is requested

Your child is invited to take part in a research study of ____ Insert description of the study without
using jargon. The researcher is inviting ____ Describe who meets the inclusion criteria (example: “all
Sunnyside High School students who are enrolled in an economics class”) to be in the study. This
form is part of a process called “informed consent” to allow you to understand this study before
deciding whether to allow your child to take part.

This study is being conducted by a researcher named ____ Insert researcher’s name, who is a ____
Insert role such as doctoral student or faculty member at Walden University. If recruiting participants
within the researcher’s own workplace, an additional statement is required: You may already know the
researcher as a ____, but this study is separate from that role.

Background Information:
The purpose of this study is to ____ Insert simple description of study purpose without using any
technical terms or jargon.

Procedures:
If you agree to allow your child to be in this study, your child will be asked to:
      ____Insert study procedures and how many minutes/hours each will take, preferably as a
        bulleted list. Be clear about how many times data will be collected. If the child will be in a
        classroom or group setting, be sure to explain what the non-participating children would be
        doing during data collection so the parent can fully understand the options.
      ____
      ____

Here are some sample questions:
____ For questionnaire/interview research, provide a few sample questions.

Voluntary Nature of the Study:
This study is voluntary. Everyone will respect your decision of whether or not you want your child to
be in the study. Of course, your child’s decision is also an important factor. After obtaining parent
consent, the researcher will explain the study and let each child decide if they wish to volunteer. No
one at ____ Insert all relevant institutions or agencies will treat you or your child differently if you or
your child decides to not be in the study. If you decide to consent now, you or your child can still
change your mind later. Any children who feel stressed during the study may stop at any time.

Risks and Benefits of Being in the Study:
Being in this type of study involves some risk of the minor discomforts that your child might encounter
in daily life, such as ____ Insert any relevant minor risks, such as fatigue, stress or becoming upset.
Being in this study would not pose risk to your child’s safety or wellbeing. If the study possibly involves
more than minimal risk of harms that go beyond normal daily experiences, the preceding two
sentences should be replaced with a tailored description of the potential harms of the study. If
possible, describe “risks” in terms of both the estimated likelihood of harm and estimated magnitude
of harm.

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Describe the study’s potential benefits without overstating the benefit to the individual.

Payment:
Describe any payment, thank you gifts, or reimbursements that you are providing to participants, or
state that there is none. Extravagant payment is discouraged but if there is a thank you gift, explain
when/how the participant will receive it.

Privacy:
Any information your child provides will be kept ____ Insert either the word confidential or
anonymous (note that while anonymity is preferred, it only applies in studies in which no one, not even
you as the researcher knows who participated, i.e. a survey with consent implied through completion
of that survey). The researcher will not use your child’s information for any purposes outside of this
research project. Also, the researcher will not include your child’s name or anything else that could
identify your child in any reports of the study. The only time the researcher would need to share your
child’s name or information would be if the researcher learns about possible harm to your child or
someone else. Data will be kept secure by ____ Briefly describe security measures. Data will be kept
for a period of 5 years, as required by the university.

Contacts and Questions:
You may ask any questions you have now. Or if you have questions later, you may contact the
researcher via ____ Insert researcher’s phone number and email address. If you want to talk privately
about your child’s rights as a participant, you can call Dr. Leilani Endicott. She is the Walden
University staff member who can discuss this with you. Her phone number is 1-800-925-3368,
extension 1210. Walden University’s approval number for this study is IRB will enter approval
number here and it expires on IRB will enter expiration date.

The researcher will provide an extra copy of this form for you to keep.


Statement of Consent:

I have read the above information and I feel I understand the study well enough to make a decision
about my child’s involvement this optional research project. By ____ Insert the phrase that matches
the format of the study: (signing below) (replying to this email with the words, “I consent,”) I
understand that I am agreeing to the terms described above.

Tailor the signature section below as needed if using paper consent forms.


 Printed Name of Parent


 Printed Name of Child


 Date of consent


 Parent’s Signature


 Researcher’s Signature




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