Child/Adolescent Survey: Care of Children and Adolescents with Diabetes Mellitus While in School and School Associated Activities

 
1. This questionnaire is for children with diabetes and their parents and guardians. We would really like both to answer these questions separately. The questionnaire is exploring a child's experience with diabetes in the school system. Your participation is voluntary and you will not be asked to identify yourself or your child in the study. Children can complete without a parent completing and a parent can complete without their child. We do hope to get as many opinions and experiences as possible. We appreciate your time and consideration.


I give my permission to the above named researchers to use my responses in this questionnaire for research purposes. I am aware that I am voluntarily completing this form and there is no penalty should I refuse to complete it. In addition, I am aware that I will not be identified by my answer. I am aware that my responses will be kept in confidence and in no way will be used to report back to my health care provider or school system. I can review the overall results of the study, if I choose to, by sending a written request to the researchers. Since you are below the age of 18 both you and your parent or guardian must agree to these terms in order to complete the survey.

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