ࡱ> 574] 1bjbj 8"؜)\؜)\ 2ttttt8$;(   $!ttt  ///Rt t /// @`@ MF 0;,A"A"A"t//;A"> ::  SAMPLE PARENTAL CONSENT FORM This document may serve as a guide or a template for your actual Parental Consent or Informational Letter. All the information in this sample form must be included in the Parental Consent or Informational Letter submitted to IRB for review. You may choose your own format if desired. Parental Consent is required for any subjects under 18 years of age, along with a Child Assent Form. INFORMATION ABOUT: give title of study BALDWIN WALLACE UNIVERSITY BEREA, OHIO 44017 RESPONSIBLE INVESTIGATOR: give name of responsible investigator and co-investigator DATE OF PREPARATION OR REVISION: My child has been asked to participate in a research study that investigates describe purpose of investigation, how it relates to other knowledge on the topic(s) and what use may be made of the results obtained In participating in this study I agree to allow my child to describe briefly and in lay terms procedures to which parent is consenting. Be specific in describing treatments or tests, how often and how much given, time limits of study, invasive techniques, any restrictions on normal activities, long term follow-up examinations or the possibility of receiving inactive material in a double-blind trial. The parents should understand exactly what they are agreeing to allow their child to do by consenting to them being in this study. I understand that: a) The possible risks to my child of this procedure include list known risks or side effects: if none, so state; if unpredictable, so state; include measures that will be taken to minimize hazard or discomfort. b) The possible benefits of this study to my child are known treatment benefits; if none, so state. c) Any questions I have concerning my childs participation in this study will be answered by first and last name(s) and degree(s) of investigator(s) available to answer questions and phone number(s) where the person may be contacted. d) I understand that I may refuse to allow my child to participate or may withdraw my child from this study at any time without any negative consequences. Also, the investigator may stop the study at any time. I also understand that no information which identifies my child will be released without my separate consent, and that all identifiable information will be protected to the limits allowed by law. If the study design or the use of the data is to be changed, I will be so informed and my parental consent re-obtained. I understand that if I or my child have any questions, comments, or concerns about the study or the informed consent process, I may write or call the Office of the Provost, 鶹APP, 275 Eastland Road, Berea, Ohio 44017, 440-826-2251. I acknowledge that I have received a copy of this form. e) I have received a copy of or access to this parental consent form. f) This study is supported by funding from funding source must be listed only if is a commercial company. I have read the above and understand it and hereby consent to the procedure(s) set forth for my child. 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J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 1 " 1114 1 1 +-4!8@0(  B S  ?      / 2       / 2 `h;o{m(<Jmms{   " + 7 7    , ] ^ _      , - 2 'ihh^`OJQJo(hHh^`OJQJ^Jo(hHohr ^r `OJQJo(hHhB^B`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohR^R`OJQJo(hH'i         XR&D5, 53Ee?`A?tKxMNA}RvNY$bm+fUzyz::s^ s6F7K*N:kH`3q7\? @  1 @UnknownG.Cx Times New Roman5Symbol3. *Cx Arial3.Cx Times?= *Cx Courier New;WingdingsA$BCambria Math"hX#('^#('  !xr0 [ 3qHX $Ps2!xx SAMPLE INFORMED CONSENT FORMATBaldwin Wallace College Jaimy Dyer Oh+'0   @ L Xdlt| SAMPLE INFORMED CONSENT FORMATBaldwin Wallace CollegeNormal Jaimy Dyer6Microsoft Office Word@V@x@  ՜.+,0 hp  Baldwin-Wallace College  SAMPLE INFORMED CONSENT FORMAT Title  !"#%&'()*+-./01236Root Entry F@B 81TableQ"WordDocument8"SummaryInformation($DocumentSummaryInformation8,CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q