Two variants. Use the one that matches your participants' age and reading level. Parental permission is also required.
What is this? We want to learn about [FILL IN]. We are asking if you want to help us.
What will happen? If you say yes, you will [FILL IN]. It will take about [FILL IN].
Will it hurt? [FILL IN: "No" or honest plain answer.]
Do I have to? No. You do not have to. You can say no, or you can stop any time.
Any questions? You can ask [FILL IN: researcher first name] anything.
I want to help with this study.
Child's Name:
Child's Signature or Mark / Date:
Purpose: You are being invited to take part in a research study about [FILL IN].
What You Will Do: [FILL IN: procedures, duration, location.]
Risks: [FILL IN]
Benefits: You may not benefit directly, but this study may help [FILL IN].
Privacy: Your answers will be kept private. We will not tell parents or teachers your specific answers. The only exception is if you tell us something that makes us worried about your safety.
Your Choice: Taking part is your choice. Your parent has said it is okay, but you still get to decide.
Questions: Contact [FILL IN: researcher name, email].
I have read this form and agree to take part.
Participant Name (printed):
Participant Signature / Date: