MINOR ASSENT FORM
Title of Tour or Project: ___________________________________________________
Age and Physical Condition: I state that I am a minor below age eighteen (18) years of age, in
good physical health, and wish to participate in ________________________ (with the consent of
my legal guardian) being conducted by ______________________ of West Texas A&M University.
Purpose: The purpose of the tour/project is
________________________________________________________________________________
Risks and/or Discomforts:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Benefits:
______________________________________________________________________________
Opportunity to ask Questions or to withdraw: I understand that I am free to ask questions or to
withdraw from participation at any time without any penalty.
Other Requirements: I understand that I am to abide by the rules and precautions to protect myself
and others.
Rights: Visitors may contact the Office of AR-EHS (Phone: 806-651-2270), Email:
aswindell@wtamu.edu) with questions about their rights.
Contact Information:
_____________________________________
_____________________________________
_____________________________________
_____________________________________
I authorize my child to participate in the Tour/Project described above.
_____________________________________
Signature of Parent/Legal Guardian
______________________________
Child Signature
_____________________________________
Printed Name of Parent/Legal Guardian
______________________________
Printed Name of Child
___________________
Date