Vaccine Trial Informed Consent Form
1. Participant Information
Full Name
Date of Birth
Contact Information
2. Study Information
3. Purpose of the Study
4. Procedures
5. Risks and Discomforts
6. Potential Benefits
7. Confidentiality
8. Voluntary Participation & Withdrawal
9. Who to Contact
10. Consent Declaration
I have read and understood the information provided above. I freely agree to participate in this vaccine trial.
Participant Signature
Date
Witness Signature (if required)