Note (delete this statement in the final copy): Insert applicable information in the as noted in red. Delete the
language that does not apply. Do not delete any of the major headings as these are required by regulation and local
Parental Permission for Children Participation in Research
Title: [insert title of study]
Principal Investigator: [insert principal investigator’s name]
The purpose of this form is to provide you (as the parent of a prospective research study participant)
information that may affect your decision as to whether or not to let your child participate in this research
study. The person conducting the research will describe the study to you and answer all your questions.
Read the information below and ask any questions you might have before deciding whether or not to give
your permission for your child to take part in the study. If you decide to let your child be involved in this
study, this form will be used to record your permission.