| Informed Consent Form |
| Parent's Electronic Signature (type only first name and the first initial of your last name here): |
| If you are under the age of 18, your parents will need to look this over and sign electronically for you. If you are 18 or 19, please scroll down to sign. I give my consent for my child to participate in the research study of Stefanie Wade. I understand that this form, once it is submitted, will be kept confidential once sent to Stefanie Wade's email account. There will also be no record of my child's name or my name listed in the study. I also understand that my name and my child's name will not be used for marketing purposes or sold to any lists. Our email addresses, if given, will also be kept confidential. Because I am not giving my last name, my identity will be kept private, as will my child's. |
| example: Stefanie W. |
| In signing this form electronically, I certify that I am the parent or legal guardian of the child completing the questionnaires and that I consent to my child participating in this study. |
| OR (if you are 18 or 19):
I consent to participating in the research study of Stefanie Wade. I understand that this form, once it is submitted, will be kept confidential once sent to Stefanie Wade's email account. There will also be no record of my name listed in the study. I also understand that my name will not be used for any marketing purposes or sold to any lists. My email address, if given, will also be kept confidential. Because I am not giving my last name, my identity will be kept private. |
| Subject's Electronic Signature (type only first name and the first initial of your last name here): |
| example: Stefanie W. |
| In signing this form electronically, I certify that I am the person stated in the signature and that I consent to participating in this study. |
| **** to get the signature box to work, click on the far right upper arrow first**** |
| **** to get the signature box to work, click on the far right upper arrow first**** |
| ***This page does not link to the others, so when you have submitted this form, please use your back button to get to this page again and then click the questionnaires button . Please do this after submitting this form*** |
| **After you submit the consent form, you will see a white page. Click on the BACK button of your browser to get to the questionnaires' link at the bottowm of this page** |
| Link to The Questionnaires **Make sure you have submitted the informed consent first** |
| Child's Age: |
| Child's Sex: |
| Age: |
| Sex: |
| Please also choose a 3 digit number that you will also use on the questionnaire. This will help ensure that each questionnaire has an informed consent with it. However, your anonymity, as well as your child's will be kept private because you have not given your last name. |
| Please also choose a 3 digit number that you will also use on the questionnaire. This will help me ensure that each questionnaire has an informed consent with it. However, your anonymity, as well as your child's will be kept private because you have not given your last name. |
| ********************************** |
| ********************************** |
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| 3 Digit Number click on upper arrow FIRST |
| 3 Digit Number click on upper arrow FIRST |
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| **After you submit the consent form, you will see a white page. Click on the BACK button of your browser to get to the questionnaires' link at the bottowm of this page** |
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| If text is overlapping on this page, email me at [email protected] |
