Pediatric Research Parental Consent Form

Study Title:

Principal Investigator:

I have read and understand the information provided above. I voluntarily agree to allow my child to participate in this research study.

Child's Name: Date of Birth: Parent/Guardian Name: Relationship to Child: Signature:

Date:

I have explained the research to the parent/guardian and answered all questions. I believe that the parent/guardian understands this information and has freely given consent.

Investigator’s Name: Signature:

Date: