Pediatric Research Consent Form
Study Title
Principal Investigator
Name
Contact
Introduction
Purpose of the Study
Procedures
Risks and Discomforts
Benefits
Confidentiality
Voluntary Participation
Withdrawal
Contact Information
Parent/Guardian Consent
I have read and understood the information provided above. I voluntarily agree for my child to participate in this study.
Signature
Parent/Guardian Name
Signature
Date
Child Assent (if applicable)
Child Name
Signature
Date