Parental Consent Letter (SAMPLE LETTER) Dear Parent/Guardian: The ___________________________and Fordham University are working together to learn better ways for adults to work with children, especially when they are upset. As part of our work we would like to talk to your child about when he or she becomes upset or angry. Since your child’s participation in this work is voluntary before we can talk to him or her we need your permission. If you do not give your permission there will be no change in your child’s treatment program. If you give your permission, we will ask your child to answer some questions about themselves and other people. Your child may also be interviewed for 15-20 minutes by a Fordham University researcher. Your child will be asked to describe what happens when they become upset or angry, and how the adults who work here responded to them. Your child can talk a little or a lot. Your child can even refuse to answer any or part of the questions. Either you or your child can withdraw consent at any time. There will be no changes or repercussions in your child’s treatment if either you or your child withdraws consent at any time. The talk or the answers to the questions will not be part of your child’s treatment record, and there will be no changes in your child’s treatment because of the answers. The Fordham researchers will keep all their conversations confidential or private. No names will be used when they report what they have learned. What your child says will only be used to help in our work to make things better for the children who live here. If it is all right for your child to participate, please sign the study CONSENT at the bottom of the page. Even if you decide not to give your permission, please return this letter to the person who gave it to you. If you have any questions, please feel free to contact me at ______ or_______ at ________________. Thank you for considering this request. Sincerely, Signature of Researcher I voluntarily give my permission for my child to participate in a collaborative study between Fordham University and ___________________ have read and understand the letter describing the purpose and procedures of the study and have been given the opportunity to ask questions about them. I understand that either I or my child may ask questions and that either of us may withdraw our permission at any time with no repercussions to my child’s treatment plan.
_________________________________ Child’s Name (Please Print) ______________________________________________________________________ Signature of Parent Date