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SAMPLE CHILD ASSENT

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					                                           CHILD ASSENT TEMPLATE


Assent forms vary widely since they must be tailored to the particular age range and abilities of children to be
involved in a particular study. Written assent should be obtained from any child with an intellectual age of 7
years or more. This template provides an example for children ages 7-12 but can be adjusted for older children
by modifying the language. If appropriate, children under 7 should be given the opportunity to understand and
assent to participation in a study, whether clinical or behavioral. It is acceptable to read the assent document to
these younger children. If assent is provided verbally, an assent script must still be included as part of the IRB
application.


                                            (Title of Research Project)

Researchers from the University of West Florida (name the department) are trying to learn about (insert
research objective in terms appropriate to the age of the children). You have been asked to participate because
(brief explanation why the participant is being selected to participate in the research.) If you decide to participate
in this study, you will be asked to (list the actions that the child will be asked to complete). You will be asked
about (describe the sorts of questions the subject will be asked, if applicable). Some things may make you
uncomfortable such as (If appropriate, include a sentence about whether or not the procedure will involve any
risks & what they are). This study will take place (name the location of the study) and should take about
(estimate time involvement) of your time.

The researchers hope this study will help (explain the anticipated benefits of the research, both to the participant
if appropriate, or to other children, or to society in general. If appropriate, discuss any compensation the child
may receive such as a toy or gift certificate.)

You do not have to be in this study if you don’t want to and you can quit the study at any time. If you don’t like a
question, you don’t have to answer it and, if you ask, your answers will not be used in the study. No one will get
mad at you if you decide you don’t want to participate.

Other than the researchers, no one will know your answers, including (name people that will not have access,
i.e., strangers, teachers, friends, other children, etc.) If you have any questions, just ask the (name researcher).


This research study has been explained to me and I agree to be in this study.


______________________________________ ____________________
Subject’s Signature for Assent                     Date


Check which applies to be completed by person conducting assent discussion):

 The subject is capable of reading and understanding the assent form and has signed above as documentation of
    assent to take part in this study.


 The subject is not capable of reading the assent form, however, the information was explained verbally to the
    subject who signed above to acknowledge the verbal explanation and his/her assent to take part in this study.



Name of Person Obtaining Assent Print)


Signature of Person Obtaining Assent                                Date