Your signature documents your permission for the named child to take part in this research. ______________________________________________________ __________________ Signature of child Date ______________________________________________________ Printed name of child ______________________________________________________ __________________ Printed name of parent [ ] or individual legally authorized [ ] Date to consent for the child to participate ______________________________________________________ __________________ Signature of parent [ ] or individual legally authorized [ ] Date to consent for the child to participate ______________________________________________________ ____________________ Signature of person obtaining parent permission and assent Date ______________________________________________________ Printed name of person obtaining parent permission and assent
Your signature documents your permission for the named child to take part in this research. ______________________________________________________ __________________ Signature of child Date ______________________________________________________ Printed name of child ______________________________________________________ __________________ Printed name of parent [ ] or individual legally authorized [ ] Date to consent for the child to participate ______________________________________________________ __________________ Signature of parent [ ] or individual legally authorized [ ] Date to consent for the child to participate ______________________________________________________ ____________________ Signature of person obtaining parent permission and assent Date ______________________________________________________ Printed name of person obtaining parent permission and assent
example-parent-permission-child-assent%205-31-2016.docx