Minor Assent for Survey Participation
Study Title
What is this survey about?
What will I have to do?
Will anything bad happen if I join?
Will anything good happen if I join?
Do I have to be in this survey?
Who should I talk to if I have questions?
Your Agreement
Your Name:
Your Signature:
Date:
Parent/Guardian Consent
Parent/Guardian Name:
Parent/Guardian Signature:
Date: