MASTERING LIFE - YORK UNIVERSITY MASTERS CHESS SURVEY 

* 1. Informed Consent Form

Date: September 27th, 2015

Study Name: Mastering life: Investigating correlates of physical activity, sport, and biopsychosocial well-being among older adults

Researchers: Dr. Joe Baker, Ms. Rona El-Bakri, Ms. Shruti Patelia, and Ms. Rachael Stone, School of Kinesiology and Health Science, 338 Bethune College, York University, 4700 Keele St. Toronto, ON M3J 1P3.

Purpose of the Research: This research seeks insight into health-related holistic satisfaction and physical quality of life within various levels of physical activity/sport participation and chess playing among older adults.

What You Will Be Asked to Do in the Research: Participants in this study will be required to complete a survey that includes questions with scaled items that have been validated for assessing quality of life, for example, “How would you rate your general health?” This survey will require approximately 20-30 minutes of time to complete.

Risks and Discomforts: We do not foresee any risks or discomfort from participation in the research.

Benefits of the Research and Benefits to You: There are no explicit benefits through participation; however, this information may be used to promote physical activity and health policy changes for current and future populations of older adults.

Voluntary Participation: Your participation in the study is completely voluntary and you may choose to stop participating at any time. Your decision not to volunteer will not influence the nature of the relationship you may have with the researchers or study staff or the nature of your relationship with York University either now, or in the future.

Withdrawal from the Study: You can stop participating in the study at any time, for any reason, if you so decide. Your decision to stop participating, or to refuse to answer particular questions, will not affect your relationship with the researchers, York University, or any other group associated with this project. In the event you withdraw from the study, all associated data collected will be immediately destroyed.

Confidentiality: All information you supply during the research will be held in confidence and unless you specifically indicate your consent, your name will not appear in any report or publication of the research. Data will be collected by questionnaire and your data will be safely stored in a password-encrypted computer in locked facility and only research staff will have access to this information. Data for this study will be stored for 7 years, after which all hard copies of data will be shredded and electronic files will be deleted from relevant hard drives. At all times, confidentiality will be provided to the fullest extent possible by law.

Questions About the Research? If you have questions about the research or about your role in the study, please feel free to contact Rona El-Bakri (rbakri@yorku.ca), Shruti Patelia (spatelia@yorku.com), Rachael Stone (raystone@yorku.ca) or Dr. Joe Baker by e-mail (bakerj@yorku.ca). This research has been reviewed and approved by the Human Participants Review Sub-Committee, York University’s Ethics Review Board and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines. If you have any questions about this process, or your rights as a participant in the study, please contact the Sr. Manager & Policy Advisor for the Office of Research Ethics, 5th Floor, York Research Tower, York University (e-mail ore@yorku.ca).

Legal Rights and Signatures:
I consent to participate in “Mastering life: Investigating correlates of physical activity, sport, chess, and biopsychosocial well-being among older adults” conducted by (Dr. Joe Baker, Ms. Rona El-Bakri, Ms. Shruti Patelia, and Ms. Rachael Stone). I have understood the nature of this project and wish to participate. I am not waiving any of my legal rights by signing this form.