Pediatric Clinical Trial Consent Form
Study Information
Study Title
Principal Investigator
Institution
Child Participant Information
Child's Name
Date of Birth
Medical Record Number
Parent/Guardian Information
Name
Relationship to Child
Purpose of the Study
Procedures
Risks and Discomforts
Benefits
Confidentiality
Voluntary Participation
Contact Information
Contact Name
Telephone
Email
Consent
Parent/Guardian Signature
Date