Parent Consent Form

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Research Study Consent - English

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Water Safety with Colins and Friends
Research Study Consent Information

INVITATION AND PURPOSE
Your child is being invited to take part in a research study assessing the effectiveness of the Water Safety with Colin and Friends program. This study is being conducted by Kelly S Frindell, PhD, on behalf of Colin’s Hope.

WHAT WILL HAPPEN
Your child will complete a water safety questionnaire 2 times, once at the beginning and once at the end of the program, with the help of a research assistant. It will take approximately 5 minutes to complete the questionnaire, and your child may stop at any time.

PARTICIPANTS’ RIGHTS
You or your child may decide to stop your child’s participation in the research study at any time. You have the right to ask that any data supplied to that point be withdrawn/destroyed. There is no penalty for choosing to withdraw.

BENEFITS AND RISKS
This study poses no known risks to your child. It does not provide any tangible benefits beyond advancing scientific knowledge.

COST, REIMBURSEMENT AND COMPENSATION
Your child’s participation in this study is voluntary. There is no cost to participate, and there is no reimbursement for participation.

CONFIDENTIALITY/ANONYMITY
The individual data collected will only be seen by members of our research team and will not be linked to any identifying information (e.g., name) that you supply. The data collected may be presented at conferences and in academic publications. However, we will only present data averaged over many participants. Neither your data nor your child’s individual data will be personally identifiable.

FOR FURTHER INFORMATION
If you have any questions as a result of reading this information sheet, please contact: Kelly S Frindell at 512-524-6877 or [email protected]. If you have questions, comments, concerns or complaints about the research study that you would like to discuss with someone independent of the study, please contact Solutions IRB at [email protected] or by phone at (855)266-4412.
Consent*
I agree to allow my child to take part in the above research study. By signing below, I agree to allow my child to take part in the research study. I understand that this e-signature is legally binding.
Parent or Guardian's Signature*
Parent or Guardian's Name*
First Last
Date*
MM slash DD slash YYYY
Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Teacher's Name*
First Last
School Name*
School Zip Code*
Has your child had swim lessons before?*
- Yes
- No
If Yes, when?
Language spoken at home*
- English
- Spanish

Research Study Consent - English

Water Safety with Colins and Friends Research Study Consent Information

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Water Safety with Colins and Friends
Research Study Consent Information