Yuyo

Human Informed Consent Form
Instructions to the Student Researcher(s): An informed consent/assent/permission form should be developed in
consultation with the Adult Sponsor, Designated Supervisoror Qualified Scientist.
This form is used to provide information to the research participant (or parent/guardian) and to document written
informed consent, minor assent, and/or parentalpermission.
• When written documentation is required, the researcher keeps the original, signed form.
• Students may use this sample form or may copy ALL elements of it into a new document.
If the form isserving to document parental permission, a copy of any survey or questionnaire must be attached.
Student Researcher(s):
Title of Project:
I am asking for your voluntary participation in myscience fair project. Please read the following information
about the project. If you would like to participate, please sign in the appropriate box below.
Purpose of the project:
If you participate, youwill be asked to:
Time required for participation:
Potential Risks of Study:
Benefits:
How confidentiality will be maintained:
If you have any questions about this study, feel free to contact:Adult Sponsor: __________________________ Phone/email: ____________________________________________
Voluntary Participation:
Participation in this study is completely voluntary. If you decide notto participate there will not be any negative
consequences. Please be aware that if you decide to participate, you may stop participating at any time and you may
decide not to answer any specificquestion.
By signing this form I am attesting that I have read and understand the information above and I freely give my
consent/assent to participate or permission for my child to participate.Adult Informed Consent or Minor Assent
Printed Name of Research Participant:

Date Reviewed & Signed:
Signature:

Parental/Guardian Permission (if applicable)

Date Reviewed & Signed:...