consent-form-example

InformedConsentFormExampleThisisanexampletypeofinformedconsentformforprojectsnotdealingwithmedicalresearch,children&youngadults,peoplewithlearningdifficulties,crime,internetresearchand/orresearchwithinorganisation/workplace.I,theundersigned,confirmthat(pleasetickboxasappropriate):1.Ihavereadandunderstoodtheinformationabouttheproject,asprovidedintheInformationSheetdated________________.2.Ihavebeengiventheopportunitytoaskquestionsabouttheprojectandmyparticipation.3.Ivoluntarilyagreetoparticipateintheproject.4.IunderstandIcanwithdrawatanytimewithoutgivingreasonsandthatIwillnotbepenalisedforwithdrawingnorwillIbequestionedonwhyIhavewithdrawn.5.Theproceduresregardingconfidentialityhavebeenclearlyexplained(e.g.useofnames,pseudonyms,anonymisationofdata,etc.)tome.6.Ifapplicable,separatetermsofconsentforinterviews,audio,videoorotherformsofdatacollectionhavebeenexplainedandprovidedtome.7.Theuseofthedatainresearch,publications,sharingandarchivinghasbeenexplainedtome.8.IunderstandthatotherresearcherswillhaveaccesstothisdataonlyiftheyagreetopreservetheconfidentialityofthedataandiftheyagreetothetermsIhavespecifiedinthisform.9.Selectonlyoneofthefollowing:IwouldlikemynameusedandunderstandwhatIhavesaidorwrittenaspartofthisstudywillbeusedinreports,publicationsandotherresearchoutputssothatanythingIhavecontributedtothisprojectcanberecognised.Idonotwantmynameusedinthisproject.10.I,alongwiththeResearcher,agreetosignanddatethisinformedconsentform.Participant:___________________________________________________________________NameofParticipantSignatureDateResearcher:___________________________________________________________________NameofResearcherSignatureDate