ࡱ> DGCy  bjbj :5{{9NNNNNbbb8,bPT,$S*QN"*NN{XNN͜((0(dNd** :  ASSENT TO PARTICIPATE IN RESEARCH  FORMTEXT [Insert title of study] 1. My name is  FORMTEXT  [identify yourself to the child by name and affiliation].     2. We are asking you to take part in a research study because we are trying to learn more about  FORMTEXT  [outline what the study is about in language that is both appropriate to the child s maturity and age].     3. If you agree to be in this study  FORMTEXT  [describe what will take place from the child s point of view in language that is both appropriate to the child s maturity and age].     4.  FORMTEXT  [Describe any risks to the child that may result from participation in the research.]     5.  FORMTEXT  [Describe any benefits to the child from participation in the research.]     6.  FORMTEXT  [Explain whether the information they provide will be disclosed to any adult. If it will remain confidential, explain how the information will be kept private.]     7. Please talk this over with your parents before you decide whether or not to participate. We will also ask your parents to give their permission for you to take part in this study. 8. If you dont want to be in this study, you dont have to participate. Remember, being in this study is up to you and no one will be upset if you dont want to participate or even if you change your mind later and want to stop. 9. You can ask any questions that you have about the study. If you have a question later that you didnt think of now, you can call me  FORMTEXT DFH\^` ƶƈzpj`ZM`=Z3h!*hs6CJjhsCJUmHnHujhsCJU hsCJjhsCJU h5CJh5CJOJQJhsh56CJOJQJ*hshs6CJOJQJaJmHnHu.jhshs6CJOJQJUaJhshs6CJOJQJaJ(jhshs6CJOJQJUaJhsh55CJOJQJh55CJOJQJh!*5CJOJQJFJ L   | ~ V X  h8p h^h`gds$ h8p a$$ h8p h^h`a$$a$$a$$a$gds$a$gd!* : > F H  " $ & ( * L N b d f h j l p x z F J R T V X ^ ` t v x z |   "6؎ h!*CJjhsCJUj(hsCJUjhsCJUh!*hs6CJj@hsCJU h5CJjhsCJUjhsCJUmHnHu hsCJ hs6CJ768:<@*0z~gh<@HJtvJLTһһһ|oeh!*h6CJjhCJUhh6CJjhCJUmHnHuUjhCJU hCJjhCJU htCJ h5CJ hs6CJh!*hs6CJ hsCJjhsCJUmHnHujhsCJUjhsCJU'fgXZLNh| gd5 h8p h^h`$ h8p h^h`a$ [insert your telephone number]     or ask me next time.  FORMTEXT  [If applicable: You may call me at any time to ask questions about your disease or treatment.]     10. Signing your name at the bottom means that you agree to be in this study. 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