ࡱ> QSPi \bjbj D{b{b( nnn8#555H#J#J#J#J#J#J#$s%)(n#n5@555n##5R8nH#5H#!V">h"4##0#"<(-(0""8(n"<555n#n#555#5555(555555555 B :   SHAPE \* MERGEFORMAT  Child Assent Form Ӱ Title of Project: [Provide title of research study] Principal Investigator: [Include contact information office/mailing Address, email address, telephone number] Advisor: [REMOVE if PI is not a student Include contact information Office/mailing address Email address, telephone number] Other Investigator(s): [REMOVE if there are no other investigators] We are doing a study to learn __________. We are asking you to help because we dont know very much about ________. If you agree to be in our study, we will ask you to _________. What we learn in this research may help other children with __________. Its possible you will feel ___________. You may ask us questions at any time. You may ask to skip a question, or to stop at any time. The questions we ask are only about what you think. There are no right or wrong answers because this is not a test. If you sign this paper, it means you have read / have been told about our study and you want to be in it. If you dont want to be in the study, dont sign the paper. Being in the study is up to you, and no one will be upset if you dont sign the paper, or if you change your mind later. Childs Signature __________________________________________ Date _________________ Signature of Person Obtaining Assent: _____________________________________ Date ____________     PAGE 2 MC IRB 7.13 IRB USE ONLY: This informed consent form has been approved by the Ӱ College IRB for use with Protocol # Approval Date: Expiration Date: $6;=FPQRe  }  ݻջջ}vkhQSh<<CJ^J hZy5CJhRnh<<5;^JhZy56CJ]aJhZy6CJ]aJhZy5CJ\aJhZyCJaJhZyCJ$aJ$hZyCJ aJ "jh(CJ UaJ mHnHuh(CJ aJ jh(CJ UaJ hZy56CJ\]aJjhZyU$6QRF ] ~  0*$gd<<@&gd<<$a$gd<< $@ ^@ a$gdZy$p^p`a$gdZy$a$gdZy $^a$gdZy$a$gd($a$gdZy 3 = p ~ < = b *}yr}jahZy6CJaJhZyCJaJ hh<<hM=h<<h<<0JmHnHu h<<0Jjh<<0JUhJ jhJ UhZyhZyCJ h<<5CJhQSh<<CJhQSh<<@CJ^Jh@CJ^JhQSh<<5@CJ^Jh(@CJ\^JhQSh<<@CJ\^J& > ?  R < =  0*$gdZy $ 0*$a$gd<<1$gd<< 0*$gd<< *7GYZ[\ 0*$gdZygdZyh]hgd<< &`#$gd<<*37YZ[\hZyhZyCJhJ hZyhZy5CJ\aJhZy5CJaJ.:p<</ =!"#$8% n([|xxzPNG  IHDR1isRGB pHYs+tEXtSoftwareMicrosoft Office5q(IDATx^]XUY^ (:c9==؁]#vvbv`**`"z˹ 3Ϭ?>Zz:v>Ǥr8Q,f elll-Y,?O_]gq]S'qL hN@"_wI%g1>r5 XӥM)E;K G;/uLbA$R޾  1I,7>죤LS=W☘ǿ՜93œ'5woSKRrKkR(OX=ջd͒A [2Ej^c沭6y8&I,>} Iբ2{m/mP/J2R>ͰE!V!;46_ل;<lT'ċ_"$^4W%9.Q$ᣔ+G#)}I)<[Eek,e#ú"kw{/>GϙU}GɫWe4_ Y^x:7;ߙk∗ܦQUIkE !/p;Yyu0o7Im# S,ݰWf^'ah׶Q熅INߦN-.ˈ}|Y]V,&wcK6ygX-:$[y,Οr5-*%ݩ=%3iҤB j?}ȼ$A2G7WI㊵R^qWv'^Cʤ2XR%~uq+vH emЩ+/[%bc¡I}yΙHl2ӭq>nC{iQ,[4)x2dI1y6xˌyä{kQyŜ$񋕋b(2۱s[:A9||\'-S$t%kprf`Q85ҦI.-+\~/BH(/9C)3ΛMx -bWo+_y1q.ߒ{j:O aI߉P|!;%_W<`6{v@b14UAZȲtIRtjMc))Yo~$g.ݔ2E5y}-ZkqOf,VpUJIOt$tL$yt|~I+yBgx]jU*a(_Jk z>~LEob$@[PC r\v8$O$#][J֌i so%dUV崤7 c@VR%quU% ̻>˝=\m/,K+n*A^jJȂUJps=q1R,U87j EM]X/qqa,#iIu~ gdhzn.1$Nl/+Na}<I˿t1*%#eߥ[(ƫg/~ 2ihGؤbkYTJn3m;_aۭVbQY|5;4J% XK7˃O]Q\vWKAބED SKpS`[U~aZd{4C4K Q6o?.גŜEVJ}$/5|s*zaM Q=ԅ i+er_blF`l&j(eŇ)Z99G,F.纕4#k;+w`~-bQ)#">)79OnѰKbSdN+rgy"?U0`DDS6xSvkm {l[ge\(f8bDH FL̏OTGΙ˲)7Q ry8MYn}D;p^g8w9u,X[xς50f}Zd`2c1K8 C:FI'dw * k7{oBs47ET!fr8*}ǥy݊*g y d&\\I2 7)n,YN6Ao$dBrf:#@&ZN5z9kYP.k2jJB4ojWdp= ~;Fa6K5'A6ƒR2x%!g [.,*eάUSVݴ 4Vc{+I8Hd< ߥ簂R{V!͗3ƅviZty.䗎K ۰)~<+=y@,^[,},8aq4__{{{~wxD8Az[|bs-P?~̟3*0vT(IZBnF& -pS~dMw@t^A,Ӵve9}#ex=wI iIV?mnc#w_FF3#X#Wo](q󌣸_BBZT 0Y&5b}{%)$\yDpRoXFΈ;F⤾e5c=6SfL(Н`u<]v/oQDdZ =n@;_F¿ ֎RxjD|Wlq@7IV.]P||U݋IKD4#S`{9UdXb,B&;@sBXbBIcZKLQmq)N^}(IbT( ?/1OԆNz-5 `:YWn>),!"ڱ<6 T族l8FKrMi}duΠ}p#<^]"Se_\6Pb8*zr-)Ov*t{e6wrO)rdFcFZ$[P(^ 2Cjyn;Bf"uttQ,n7D+㦸yӫȒN\/[8j"Q%S͗GҥnF #b^[3BI+"SM{lÀ:GBYh(/Y$Y3Tf"1YRsWn)kܻKEd(/+F x+ƵCJZ7*-\DI~@66i:F2~** g6hjq6%lxkMkWc2/^$XLƪx6OSZM~$sg\# do:ܔҬneq:1 .(z}$3J'2\ 7•YsbN@QT3D4sII34cg OyP`45 _8F6ɐ plȍ6Jy x`&+}bS9u)̕;U},Ѱ)K}PRoJ)w?!ua%0LdȔVY2lKz1fJ8 O0e"5PBf䞷.GD|P9ឿ6@-P׫,o%_ Kl߰h@ʒ4`9HGW'9H~kD8ɐ̐#KzYPj[.kүS#lp ^!O{#-TA ѳuj B#f'Sw$X]Ǿ4ΥK2htċHU2R)VS,sKJ8^yoZRCG &Ru̢cq3X{2mm_$d$uMet]zC̜.-mI z#LִqMm"-_VL\&b+%A5B߳U-3ƔRK&OO?hae~8Fb=BbXXM[S-&׾2 s+xF GbV!g/kͮw6eKt0s|3 O](p5O+hy22a!, /N. C4FX삑13VR.;HWP?ӥ `t) Jvcr@X-^h"N]s,>\vݲ ~G&$ӛӣm}0\YͺWz"P(UO.BBSLY QEFK "0QڹXsiة+e2StYVn> X~VMy/*u#:GYպUKU\v,T^u>ьY aRvֶti)[,ߚoE( %H3|Sπ~}۪?&/_#S!ͅa$U)ȈO9ϴ^w}G]JR`>l˳Q#nS4WIlcVw麄+0z ;\Sdxu=_LLdu,U`"czʔNqEx..w5'!5 J|d:!>{5L֤?*.:O#b)eSoa'K* mN"Q1 *4sA;;sp&7.dZ~D(bFRҵIxpCg+wTD0]=LvZr0o/+^fPBX 7;[=OF|,x>ǚbY7~j ArGCbc\4j?J"\,v&u*  rV-WTڳxZjCk2NED Z}3+۷֪l~9p܄U~IeC' qUWl40ҚGHD.r`" 1  }Q]; jJG4l)W~O <AƲ **%/-,. rFoykk)91T:⋥][# S2qC;Gy#$Z4q>ӭ)` j QgaSFxBقAI vtӒ.Ur @D>Gvg RN Y, 4gkߵ$LZee1|<>LtfͷLjN-X$ҿSc$|lt"r*ŮByE@'EҜ|U4R8*zFO4sE0;w] g7ݸ.cc~pKl'C *d\ǜ0:!E=ЫOZG_oˊ^(k=rrb(d0bT{qxeE*Mm$(,_U)|*56Wz-^<{RJf J|7>eM_En!e L!sfzyfĘa>Yϧ"έ39Ud9Y+L{0Sco( Ռƒ+Z'i h|GL3;$Ha)KmX b'׍#BZ'Q(j~X.^s,8ϦЉJ05H>H)cҔ ̱(ְ*qRJƤbQ'9N`jI_Nt麦L^lGOt":pR؁Z6W`U9anjM[}ef_iVQђRrYLT_SbєR3O|RT.oUF%o̙tI` S(&5YP%r]dYR{ѣ8\Ì9TOCw% i K-d[ɨyEY;wF |j o[$vى6*dA=66p;ElQF@m3 bU803(X}EKfG>akU=3QfI~P\7) xd˜祫H%,A `X=n S<ɌalcE]uE+z ,irK(DIF0CvҔ3 l"*g$K| *KEϋgAw;RhP vE E A Y,oke3(;Lx>Dk I5]r.2 fGdƓn`^&I|c^w`a e [daONJv=#L6ZVߔ*e`R4ȼ&5M , |57mVEKZ']jZ]vGиRr3=:Jq7j29xb7iMAS思CxbţKoA/>$>R~Gh&5 Ne&.\*sm_@nfs揌~^.vHN9P0،Iє1(b`HLfp6l,'E<:x'!@/(JV+ 7+B( >Rn2cm8Eꁌk(grA}, wW|ls -;0L[(&彌B2ޫWޗ ?iNؗcʞ-=>4`J$CuIXt;2@ٛ^RjG1ub-S}:,."T=Q:sR|L[Wzk S(P"8lV|x]Z%/0vek6c+A;5QucK2Y2/p)jY*烨] .?!Gm1Zԕ>Yb<3]K_Q ơ%Jy̵0.:% oDF~7~SXτD&U#zdN{3}t/B1Nvh17tnEp^{2%jR X%ӧg.h!H|"ejaوX+$TPS>>c+-avn,/I;5o`R̥~ρ8|k0zLjK_ߚc^S֌1c"Qw4][6'BٝnV2M@`/=ARXk,XMŅl|#=K "yUlw̿n%U$g{2BUzlxIENDB`Dd D  3 @@"?s666666666vvvvvvvvv666666>66666666666666666666666666686666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ NNormal1$CJ_HmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4 @4 N0Footer  !.)@. N Page Numbernn N Table Grid7:V01$:>@": Zy0Title $1$a$ 5\aJ:/1: Zy0 Title Char5CJ\aJ4B4 M=0Header  H$2/Q2 M=0 Header CharCJ2/a2 M=0 Footer CharCJHrH M=0 Balloon TextCJOJQJ^JaJN/N M=0Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< \\W '''* *\  \ \_ *!l,b$[|xxz(0@Z(  b  3 @@A C"?V  # "? B S  ?\ &t tZ]8=(*5Z]3333333=p~RR=b] !L  Q(X# :%% =. : +vhH K ywd  hh^h`OJQJo(h^`OJQJo(hHh^`OJQJo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHohPP^P`OJQJo(hH hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo(^`OJQJo(hH hh^h`OJQJo( hh^h`OJQJo( QK=.#:!L ywd+vhH:%%          <4*jNUr(h J (<<M=dD`Ac^Zy@\@UnknownG.[x Times New Roman5Symbol3. .[x Arial5. .[`)Tahoma?= .Cx Courier New;WingdingsA$BCambria Math hn"g!24 3qP?h{2!xxN SAMPLE PARTICIPANT CONSENT FORM smith collegeThomson, Jennifer0         Oh+'0 ( H T ` lx SAMPLE PARTICIPANT CONSENT FORMsmith collegeNormalThomson, Jennifer2Microsoft Office Word@@\u@h@h ՜.+,0 hp|  Sc  SAMPLE PARTICIPANT CONSENT FORM Title  !"$%&'()*,-./0123456789:;<=>?ABCDEFGIJKLMNORRoot Entry F n?hTData #1Table+(WordDocumentDSummaryInformation(@DocumentSummaryInformation8HCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q