Child Development Center for Learning and Research
Department of Human Development (0416)
Virginia Tech
Blacksburg, Virginia 24061
540/231-6148 Fax: 540/231-7012
www.humandevelopment.vt.edu/cdclr.html
Liberal Arts
and Human Sciences
College of
Parent Permission Form
I have read or had read to me the CDCLR Parent Handbook sections, “Educational and Research
Procedures,” and “Developmental Assessment Procedures,” and have had all my questions
answered to my satisfaction regarding these procedures. Accordingly,
(1) I recognize that in order to conduct the teaching, research and outreach missions of the Child
Development Center for Learning and Research at Virginia Tech, many forms of documentation,
assessment, and data collection will be used with the children and within the classrooms. These
can include written observations, surveys, photographs, slides, audio and videotapes, and
representations of and/or children’s actual work. I further recognize that these artifacts may be
used for educational and research purposes in public settings, including but not limited to: parent
meetings, classrooms, University display venues, such as hallways of the CDCLR; and in
professional meetings and conferences, professional communications (journal articles, papers,
book chapters) and in applications for funding. I further understand that this permission extends
not only to Center researchers, but other qualified Virginia Tech researchers who have received
approval from both the VT Institutional Review Board (for protection of human subjects) and the
CDCLR Director or Research Director, for the use of these materials and procedures.
I recognize that CDCLR staff and approved Virginia Tech researchers will seek to protect
children’s and family’s identities by using pseudonyms or first names only, not providing actual
birthdates or otherwise divulging personal identity information, unless given explicit permission
to do so by a child’s parent or legal guardian.
I understand that documentation pictures, audio and videotapes of my child will be destroyed at
my request.
I further understand that at no time will any documentation materials, assessments or artifacts be
used for commercial purposes.
I, ________________________________, for my child, _____________________________,
(name of parent/legal guardian)
(name of child)
give the following permissions to the Virginia Tech Child Development Center for Learning and
Research and Adult Day Services to: (Please initial beside each activity below, then sign and
date the document):
Invent the Future
V I R G I N I A
P O L Y T E C H N I C I N S T I T U T E A N D S T A T E
An equal opportunity, affirmative action institution
U N I V E R S I T Y
2
CDCLR Parent Permission Form continued
1. Observe and use observational data (such as statements, observed behaviors, facial
expressions, interactional tendencies) from my child within the context of the educational
process at the CDCLR (including, but not limited to, activities internal and external to the school,
events, field trips, etc). Initials: ______
2. To photograph, and use photographs from, my child within the context of the educational
process at the CDCLR (including, but not limited to, activities internal and external to the school,
events, field trips, etc). ). Initials: ______
3. To audiotape, and use data from audiotape from, my child within the context of the
educational process at the CDCLR (including, but not limited to, activities internal and external
to the school, events, field trips, etc). Initials: ______
4. To videotape, and use videotape data from, my child, within the context of the educational
process at the CDCLR (including, but not limited to, activities internal and external to the school,
events, field trips, etc). Initials: ______
5. To use photographic slides featuring my child, within the context of the educational process at
the CDCLR (including, but not limited to, activities internal and external to the school, events,
field trips, etc). Initials: ______
6. To use the art- and project work of my child for educational, teaching and research
purposes. Initials: ______
7. To conduct annual developmental assessments on my child, for educational and research
purposes. As research data, they will be used anonymously. I further understand that teachers
will use this information to help develop curriculum and will share relevant information with me
during parent conferences or as they deem necessary. Initials: ______
_______________________________________________
(signature of the parent)
Date: __________________
Last updated June, 2006
Approved by VT Institutional Review Board, #05-789 (ref 04-610), for 2008-2009
V I R G I N I A
P O L Y T E C H N I C I N S T I T U T E A N D S T A T E
An equal opportunity, affirmative action institution
U N I V E R S I T Y