Informed Consent Form

 

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Purpose and Procedures
We would like to invite you to take part in our parent recruitment registry! This is a list of parents/caregivers of children, ages birth-17 years, who may be interested in participating in research studies in the future.
 
The purpose of this project is to create a registry (list) of parents/caregivers who are willing to be contacted by researchers at SIUC about future studies. Participation is voluntary. If you choose to participate, it will take approximately 5 minutes of your time. You will complete one questionnaire about the children living in your house and your contact information. We will use this information to contact you when a new research study becomes available that focuses on children or adolescents. By being on this list, you will receive periodic notifications of current studies and invitations to participate. You are never obligated to participate, and you may freely choose whether or not to participate in any study. You will never be asked to pay to participate in these studies. Typically you will receive a gift or compensation for participating.
 
Your information will stay in our database until your youngest child turns 18 years old. We will contact you approximately every 6-12 months until this time to update your contact information. You can withdraw from the registry at any time. Your information will be kept confidential within reasonable limits. Only those involved with this project will have access to the data.
 
Contacts and Questions
This research study is being conducted by faculty members at Southern Illinois University-Carbondale who work with children. The Principal Investigator is Karla Fehr, Ph.D. The Co-Investigators are Lisabeth DiLalla, Ph.D., Michelle Kibby, Ph.D., Mary Louise Cashel, Ph.D., Sarah Kertz, Ph.D., and Stacy Thompson, Ph.D.
 
If you have any questions, please contact us at (618) 453-5490 or childstudies@siu.edu. Dr. Karla Fehr can also be reached directly at (618) 453-3554.
 
Thank you for taking the time to assist us in this research!
This project has been reviewed and approved by the SIUC Human Subjects Committee.  Questions concerning your rights as a participant in this research may be addressed to the Committee Chairperson, Office of Sponsored Projects Administration, SIUC, Carbondale, IL 62901-4709.  Phone (618) 453-4533.  E-mail:  siuhsc@siu.edu

Consent to Participate
I have read the material above, and any questions I asked have been answered to my satisfaction. A copy of this form has been made available to me for the relevant information and phone numbers. I realize that I may request to be deleted from the list at any time with no penalty by contacting Dr. Fehr.

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