IRB Informed Consent Parent-Minor Form
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Contacts and questions:
You may keep a copy of this form for your records.
Statement of Consent:
You are making a decision whether or not your child may participate. Your signature indicates that you have
read this information and your questions have been answered. Even after signing this form, please know that
you may withdraw from the study at any time.
Parent/Guardian Name Date
Signature of Parent/Guardian (Must be 18 years old to sign) Date
Signature of Researcher Date
If you have any questions, please feel free to contact me, xxxxx, (or one of the researcher’s xxxxx xxxxx at
xxx-xxx-xxxx or xxxxx xxxxx) at xxx-xxx-xxxx. You may ask questions now, or if you have any additional
questions later, we will be happy to answer them. If you have other questions or concerns regarding the study
and would like to talk to someone other than the researcher(s), you may also contact the SPCC Institutional
Review Board at IRB@spcc.edu.
I consent for my child to participate in the study. (If you are video- or audio-taping your subjects, include a
statement such as "and I agree to allow my child to be videotaped.")