ࡱ> kmj[ sUbjbjZYZY ?\83b83bB0*****>>>8vl|>S8^T("Z|47777777$a:=x79*""7**H 8"""R**7"7""#2n4kR37#80S8638=pv=0n4=*n4,"77<S8=B : , Huntsville, TX PARENT PERMISSION FOR MINOR TO PARTICIPATE IN RESEARCH  FORMTEXT [Insert title of the study.]   FORMTEXT [insert names and degrees of Principal InvestigatorFaculty Sponsor as appropriate], from the [insert department affiliation] at () are conducting a research study. Your child was selected as a possible participant in this study because  FORMTEXT [explain why the potential participant is eligible to participate]. Your childs participation in this research study is voluntary. Why is this study being done? [Describe in a few sentences what the study is designed to assess or establish. Use language that will be easily understood by the participants. Avoid jargon and technical terms.] What will happen if my child takes part in this research study? If you agree to allow your child to participate in this study, we would ask him/her to: [List and describe the procedures/tests/activities and their frequency chronologically using simple language, short sentences and short paragraphs.] [Use bullets or number the paragraphs as appropriate.] [Describe types of questions in questionnaires/surveys or interviews.] [Specify the location of study activities.] [If the study will include experimental or non-experimental procedures, please specify which procedures are experimental.] How long will my child be in the research study? Participation will take a total of about [specify time and duration]. [When appropriate, state that the study will involve long-term follow-up and specify time frames.] Are there any potential risks or discomforts that my child can expect from this study?  MACROBUTTON AcceptAllChangesInDoc  [List and describe any reasonable foreseeable risks, discomforts, inconveniences, and how these will be managed.] [If there are significant psychological risks that might cause the researcher to end the participants participation in the study, please describe them.] [If there are no anticipated risks or discomforts, please state, There are no anticipated risks or discomforts.] Are there any potential benefits to my child if he or she participates? Your child may benefit from the study  FORMTEXT [Describe benefits to participants expected from the research. If the participants will not directly benefit from participation, please state, "Your child will not directly benefit from your participation in the research."] The results of the research may  FORMTEXT [Describe the potential benefits to science or society expected from the research.] What other choices do I/my child have if my child does not participate? IMPORTANT NOTE: This section is required ONLY for research that includes treatment (e.g., behavioral therapy). IF RESEARCH INCLUDES TREATMENT: Please describe any appropriate alternative therapeutic, diagnostic, or preventive procedures that should be considered before the subjects decide whether or not to participate in the study. If applicable, explain why these procedures are being withheld. If there are no efficacious alternatives, state that an alternative is not to participate in the study. Will my child be paid for participating? (Optional section use if appropriate) Your child will receive  FORMTEXT [describe amount of payment and how and when payment will be received.]  Will information about my childs participation be kept confidential? Any information that is obtained in connection with this study and that can identify your child will remain confidential. It will be disclosed only with your permission or as required by law. Confidentiality will be maintained by means of ...  FORMTEXT [describe coding procedures and plans to safeguard data, including where data will be kept, who will have access to it, etc.] What are my and my childs rights if he or she takes part in this study? You can choose whether or not you want your child to be in this study, and you may withdraw your permission and discontinue your childs participation at any time. Whatever decision you make, there will be no penalty to you or your child, and no loss of benefits to which you or your child were otherwise entitled. Your child may refuse to answer any questions that he/she does not want to answer and still remain in the study. Your decision whether or not to permit your child to participate will not affect your current or future relations with [also include the name of institution or organization where data is being collected as may be appropriate i.e., a clinic, school, etc.]. If you decide to participate, you are free to withdraw at any time without affecting those relationships. Who can I contact if I have questions about this study? The research team: If you have any questions, comments or concerns about the research, you can talk to the one of the researchers. Please contact:  FORMTEXT [add the name of the PI and faculty sponsor as approriate] at  FORMTEXT [phone number(s)add postal and/or email address if appropriate]. Office of Research and Sponsored Programs (ORSP): If you have questions about your childs rights while taking part in this study, or you have concerns or suggestions and you want to talk to someone other than the researchers about the study, please call Sharla Miles, Research Compliance Administrator at (936) 294-4875 or write to: Office of Research and Sponsored Programs Institutional Review Board ATTN: Sharla Miles, CIP ORSP- Box 2448 Huntsville, TX 77341-2448 You will be given a copy of this information to keep for your records. SIGNATURE OF PARENT OR LEGAL GUARDIAN  FORMTEXT      Name of Child  FORMTEXT      Name of Parent or Legal Guardian   FORMTEXT       FORMTEXT      Signature of Parent or Legal Guardian Date SIGNATURE OF PERSON OBTAINING CONSENT  FORMTEXT       FORMTEXT      Name of Person Obtaining ConsentContact Number  FORMTEXT       FORMTEXT      Signature of Person Obtaining ConsentDatePLEASE NOTE: If an in-,-dfgqrs$ A B F j ʽʗʊylXyFyl9l9lh`7h OJQJ^J#h`7hbKOJQJ^JmHnHu'jh`7hbKOJQJU^Jh`7hbKOJQJ^J!jh`7hbKOJQJU^Jh`7h!2OJQJ^J#h`7h. OJQJ^JmHnHu'jh`7hOJQJU^Jh`7h. 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Be sure this method of consent is described in the application.  FORMTEXT [DELETE THIS PARAGRAPH BEFORE UPLOADING FORM INTO IRB APPLICATION]      Page  PAGE 3 of  NUMPAGES 3 T U!U)U>U@UAUBUCUEUFUHUIUKULUNUSUTUZU[U\U߿߿ߠ{{{{jUjU@(hZCJOJQJ^JaJmHnHu*)jh!hc}mCJOJQJU^JaJ h!hc}mCJOJQJ^JaJh`bjh`bU1h`7h:5>*B*CJOJQJ\]^Jphp0=j *h]\h5>*B*CJOJQJU\]^Jphp0? *h]\h`75>*B*CJOJQJ\]^JmHnHphp0u? *h]\h= 5>*B*CJOJQJ\]^JmHnHphp0u\U]UaUbUlUmUnUoUpUqUrUsUîت1h`7h:5>*B*CJOJQJ\]^Jphp0h`bhc}m(hZCJOJQJ^JaJmHnHu*)jh!hc}mCJOJQJU^JaJ h!hc}mCJOJQJ^JaJ,jh!hc}mCJOJQJU^JaJ* pUqUrUsU= 0PP&P:pEC/ =!"#8$8%hh DText27[Insert title of the study.] DS[insert names and degrees of Principal Investigator Faculty Sponsor as appropriate]DText11B[explain why the potential participant is eligible to participate]&DText20[Describe benefits to participants expected from the research. 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