Survey Consent

The purpose of this project is to understand the needs of pregnant and post natal parenting youth in Brantford & Brant County. A youth participant for this survey is defined as someone aged 16-29.

Benefits: There are many good reasons to participate in this survey.  You are invited to participate in this project because we want to hear about your experience as a pregnant or post natal parenting youth. We value your perspective and want to ensure that your voice is heard.  By participating, you’re helping to shape how maternity services are delivered in your area and are helping to identify priorities and opportunities for the coming years.

Risks: We do not anticipate any risks associated with participation in this survey. Your participation is voluntary.  You may choose not to participate. You may choose not to answer questions that you do not want to answer. If you decide to participate in this research survey, you may withdraw at any time. If you decide not to participate in the project, you will not be penalized.

If you have any questions about the project or if you experience adverse effects please contact Karen Gibbons at or Erika Andrews at

Confidentiality: Your responses are anonymous.  We will not know who participated in the survey and who did not. The survey questions will be about your supports and the obstacles you face or have faced throughout pregnancy and post natal parenting. The survey questions do not ask you to provide your identifying information.

At the end of the survey, you will be asked if you would like to be contacted about the possibility of providing an individual interview with one of the Project Coordinators. If this is something that you would like to learn more about, we will ask you to provide your name and contact information.

If you do provide contact information we will immediately disconnect it from the answers that you provided to the survey questions and store your information in a separate file.  We will then have no way of matching the answers provided to the survey questions with the personal information that you provide.

All data is stored in a password protected electronic format. It is possible that the data will be used for future community development planning.

By completing this survey, you acknowledge permission for the answers to be analyzed by the Parker’s Project Team.  Results may be included in our Final Report, publication, and presentation.  The answers will be presented in summary form in the write up or the presentation.

This project has been reviewed according to Wilfrid Laurier REB procedures for research involving human subjects.

By indicating your Acceptance below, you are agreeing that:

·        You have read and understand the above information

·        You voluntarily agree to participate

·        You are at least 16 years of age

·        You live in Brantford or Brant County

·        You have had pregnancy or post natal experience within the last 5 years

* Acceptance: