Child Assent Form

A plain-language form that explains a research study to a child and records their assent to take part, alongside a parent or guardian's signature.

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Child's Full Name

Nombre

Apellido

Child's Age

Parent/Guardian's Full Name

Nombre

Apellido

Parent/Guardian's Contact Number

I understand that I am being asked to take part in a research study. I have been told what the study is about and what taking part would involve. I understand that joining is voluntary and that I can decide not to participate, or to stop at any time.

I have been told that my answers will be kept private and that my identity will not be shared in any report about the study.

I understand that I can ask questions about the study at any point, and that I can talk with my parent or guardian about my decision to take part.

Do you agree to participate in this study?

Yes No

If you have any questions about this form or the study, please contact:

Child's Signature

Sign here

Date

Parent/Guardian's Signature

Sign here

Child Assent Form

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