“Through Your 4-Year-Old’s Eyes”
Mother and Child Consent Form
My name is Ariadne Nelson and I am a student in the Infant Mental Health program at Mills College. As part of my degree requirements, I am conducting a research study on the cognitive abilities that develop during the fourth year of life. I am considering how children think about and explain their world. I am recruiting specifically mothers and their 4-year-olds for this study. This research is supervised by Dr. Carol George, Ph.D., Professor of Psychology at Mills College.
Your child's participation will involve a 30 minute play session at the Mills College Developmental Laboratory located at Mills College in Oakland, CA. During the play session, your child and I will play a series of games while you complete a questionnaire about your experience as a parent in an adjacent room. The interactions between your child and myself will be videotaped, so that we have a record of the play session for future review. Your participation is anonymous and voluntary and the videotape will only be viewed by myself, my thesis advisor, and a research assistant (who has been approved by my advisor). At any point, you or your child can stop the session without any penalty.
Before the play session may take place, I need to gather information about you and your child. If you are interested in participating in this research, please complete this online survey. This survey will take approximately 10 to 15 minutes to complete. You will sign a similar consent form when you arrive at the Mills College Developmental Laboratory.
If you have any questions or concerns, please contact me via e-mail: firstname.lastname@example.org. You may also contact Dr. George at Mills College at 510-430-3268 or email@example.com. Each child will receive a picture book and mothers will be entered in a raffle for fifteen $15 gift certificates to Amazon.com.
Early Childhood and Family Research Laboratory
Department of Psychology
By clicking "next," I give my consent to participate in the "Through Your 4-Year-Old's Eyes" survey. I have read the letter above and understand that my participation is voluntary and confidential. I understand that I may withdraw from this study at any time.