Sample Consent Letter
I hereby consent to myself / my child (whose name is _______________________ ) being video taped, audio taped, tested, and/or observed. I understand that: (a) any information gathered (as noted above) will be used only for educational purposes and that this information may be shared with the tester's course instructor(s), with other legitimate professional and consultants and possibly with graduate students registered in the course, Education 6709. (b) if the named child is tested at the request of the counselor or another person in his or her school, where appropriate, test results may be given to the school for appropriate educational issues. (c) that all information gathered is to be kept strictly confidential and to be used only for purposes stated. (d) any video or audio recordings made of me or my child will be erased on or before December 31, 1998 unless my written consent has been given. (e) I have the right to revoke my permission at any time.
_________________________________ Signature of Consenting Parent/Guardian _________________________________ Printed Name of Consenting Party _________________________________ Signature of Tester
__________________________________ Signature of Witness-Optional __________________________________ Printed Name of Witness __________________________________ Date