AUB Social & Behavioral Sciences Parental Permission Template

Permission for Child to Participate in Research

Study Title:
Researcher:
Sponsor: [If applicable]

This is a permission form for your child/child for whom you are legal guardian to participate in a research study. It contains important information about this study and what to expect if you decide to permit your child/child for whom you are legal guardian to participate.

Your child’s participation is voluntary.

Please consider the information carefully before you decide to allow your child to participate. If you decide to permit participation, you will be asked to sign this form and will receive a copy of the form.

Purpose: [describe in nontechnical terms the purpose of the research project, include the types of questions or activities that the child will be asked to perform, observe.]

Procedures/Tasks: [describe the procedures involved, mention audio or video taping, if applicable and what will happen to the tapes after the study, e.g. shown at scientific meetings, archived for a period of time and then responsibly destroyed, etc.]

Duration:

[Insert the length of time the child will be involved in the study; if there is more than one session, describe how many sessions and the length time for each session.]

Your child may leave the study at any time. If you decide to stop your child’s participation in the study, there will be no penalty to you, or your child and you will not lose any benefits to which you are otherwise entitled. Your decision will not affect your future relationship,or that of your child, with AUB.

Risks and Benefits: [insert a description of all foreseeable risks to the child participating in the research.] [Insert a description of any direct benefits that the child might receive or gain by participation. Example: during this research your child will be shown how to play a simple board game involving two people.Your child will be permitted to keep this game as a thank you for participating in the research. ]

Confidentiality:

[Insert full description of how privacy of information and data collected will be preserved; how confidentiality of child’s participation will be protected. Explain what will happen to the research data after the study is complete. If data will be shared with other researchers at AUB or elsewhere disclose that information.] Example:

Efforts will be made to keep your child’s study-related information confidential. All data from this study will be maintained in a secure locked drawer in a locked office or on a password protected computer. Data will only be reported in the aggregate. No names of individual children will be disclosed in any reports or presentations of this research. However, there may be circumstances where this information must be released. For example, personal information regarding your child’s participation in this study may be disclosed if required by law. Also, your child’s research data may be reviewed by the following groups (as applicable to the research):

  • U.S. Office for Human Research Protections or other federal, state, or international regulatory agencies, required;
  • The AUB Institutional Review Board or Office of Human Research Protections;
  • The sponsor, if any, or agency supporting the study.

After the conclusion of the study, the Principal Investigator will retain all original study data in a secure location for at least three years to meet institutional archiving requirements. After this period, data will be responsibly destroyed.

Incentives: [insert description of reimbursement or recruitment incentive or participation incentive. If payment is prorated for partial participation in the research, be clear about what payment schedule is. If there is no payment, state as such.Make clear whether payment is made directly to the child e.g. your child will be able to select a toy of nominal value from the study toy box for participating in the project; or payment made to parent/legal guardian: you will receive $3.00 for your child’s participation in the study.]

Participant Rights:

You may refuse to allow your child to participate in this study without penalty or loss of benefits to which you are otherwise entitled. If you are a student or employee at AUB, your decision about whether or not you allow your child to participate in this research will not affect your grades or employment status.

If you choose to allow your child to participate in the study, you may discontinue his/her participation at any time without penalty or loss of benefits. By signing this form, you do not give up any personal legal rights you or your child may have as a participant in this study.

The Social & Behavioral Institutional Review Board responsible for human subjects research at AUB has reviewed this research project and found it to be acceptable, according to applicable Lebanese and U.S.federal regulations and AUB policies designed to protect the rights and welfare of participants in research.

Contacts and Questions:

For questions, concerns, or complaints about the study you may contact[Insert name of PI/Investigator and phone or email where this person may be contacted.]

For questions about your child’s rights as a participant in this study or to discuss other study-related concerns or complaints with someone who is not part of the research team, you may contact the AUB Social & Behavioral Science Institutional Review Board [INSERT PHONE AND EMAIL CONTACT INFORMATION]

Signing the consent form

I have read (or someone has read to me) this form and I am aware that I am being asked to give permission for my minor child (or child under my guardianship) to participate in a research study. I have had the opportunity to ask questions and have had them answered to my satisfaction. I voluntarily agree to give permission for my child/child under my guardianship to participate in this study.

I am not giving up any legal rights by signing this form. I will be given a copy of this form.

Printed name of subject
Printed name of person authorized to give permission for minor subject/participant / Signature of person authorized to give permission for minor subject/participant (when applicable)
AM/PM
Relationship to the subject / Date and time

Investigator/Research Staff

I have explained the research to the parent or legal guardian of the child subject/participant before requesting the signature(s) above. There are no blanks in this document. A copy of this form has been given to the parent/legal guardian of the child participant/subject.

Printed name of person obtaining permission / Signature of person obtaining permission
AM/PM
Date and time