[for studies which would not exceed minimal risk]
I am a professor [a graduate student under the direction of Professor __________________] in the Department/Division/College of _____________________ at Southern Methodist University. I am conducting a research study to __(explain purpose of study)__________________________________________.
Your child's participation will involve ___________________________. (Explain procedures and include the expected duration of the subject's participation). Your participation, as well as that of your child, in this study is voluntary. If you or your child choose not to participate or to withdraw from the study at any time, there will be no penalty, (it will not affect your child's grade, treatment, care, whichever applies - select only one). The results of the research study may be published, but your child's name will not be used.
IMPORTANT NOTE: Recent federal (and state) laws may compromise the presumed confidentiality of your data. Therefore, it is important to include a phrase such as "to the extent allowed by law" in all consent forms in the section concerned with confidentiality for subjects. For instance, in your Consent Form, you ought to include a phrase such as this: "Information obtained during the course of the study will remain confidential, to the extent allowed by law."
Although there may be no direct benefit to your child, the possible benefit of your child's participation is __________________________________________________.
If you have any questions concerning this research study or your child's participation in the study, please call [name and position] at (***)***-****.
* * * * * * *
I give consent for my child _(insert child's name here)________ to participate in the above study. (Release statement for audiotaping/videotaping or relinquishing confidentiality must be inserted here, if applicable).
Parent's Signature _________________________________
If you have any questions about your rights as a participant in this research, or if you feel you have been placed at undue risk, you can contact the Chair of the Institutional Review Board (Human Subjects Research Committee.