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I hereby consent to my participation in the following research project:
(Title of Project)
(Telephone) (Fax) (E-mail)
State the purpose of the research in lay terms, the procedures to be followed and their purposes, including any which are experimental
- Describe anything that may cause embarrassment or discomfort to the participants.
- Describe any benefits to be expected from the project to the participants or society in general.
- Describe any alternative procedures (if appropriate) which may be available.
- Provide the name(s) and the telephone number(s) of the individual(s) who would be prepared to answer questions concerning the project.
- State that the participant is free to withdraw consent and to discontinue participation in the project at any time, without prejudice.
|Signature of Subject (including children over 7 years of age)
Signature of Parent or Guardian (if subject is under 18 years of age)
Signature of Person Obtaining Consent
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