[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
The research study is
Role
Chief Investigator
Co-Investigator/s
Student
Investigator/s
Research Funder
being carried out by the following researchers:
Name
Organisation
[INSERT name of CI]
[INSERT organisation]
[INSERTa list of co-investigator/s
[INSERT a list of
name/s]
organisation/s]
[INSERTa listof student
[INSERT a list of
invesitgator/s name/s] is
organisation/s]
conducting this study as the basis
for the degree of [INSERT degree
undertaken] at The University of
New South Wales. This will take
place under the supervision of
[INSERT name and position of
supervisor/s].
This research is being funded by [list the name/s of funding
organisation/s].
What is the research study about?
Your child has been invited to take part in this research study because [INSERT reason
for invitation].
To participate in this project your child will need to meet the following inclusion
criteria:
 [INSERT inclusion/exclusion criteria]
The research study is aiming to [INSERT a brief description of the purpose, aims and
significance of your study in plain English].
Does my child have to take part in this research study?
Your child’s participation in this research study is voluntary. So it’s up to you whether
to let your child take part or not. Your decision will not affect your relationship with
The University of New South Wales [INSERT any other organisation/s].
This Parent/Guardian Information Statement and Consent Form tells you about the
research study. It explains the research tasks involved. Knowing what is involved will
help you decide if you want your child to take part in the research.
Please read this information carefully. Either you or your child can ask questions about
anything that you don’t understand or want to know more about. Before deciding
whether or not your child can take part, you should discuss it with your child. You
might want to also talk about it with a relative or friend.
If you decide you want your child to take part in the research study, you will be asked
to:
 Sign the consent form ;
HC Number:
Version dated: Day Month Year
Page 1 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]

Keep a copy of this Parent/Guardian Information Statement;
What does participation in this research require, and are there any risks involved?
If you decide that your child will take part in the research study, they will be asked to
[INSERT provide a lay description of each study task & potential risks. Please ensure
they are detailed in chronological order. Potential risks can include physical,
psychological, financial and social risks.]
[EXAMPLE study tasks & risks]
#[INSERT study tasks name]
Description: [INSERT lay description of the study task]
Risk: [INSERT describe (1) the severity & likelihood (e.g., likely, less likely or rare) for
each risk & (2) how the risk will be managed]
#[INSERT study tasks name]
Description: [INSERT lay description of the study task]
Risk: [INSERT describe (1) the severity & likelihood (e.g., likely, less likely or rare) for
each risk & (2) how the risk will be managed]
[INSERT If no risks aside are anticipated use the following statement: ]
Aside from you and your child giving up your time, we do not expect that there will be
any risks or costs associated with taking part in this study.
[EXAMPLE standard wording for common study tasks]
[FOR SCREENING OR BASELINE TESTS]
Before your child begins any activities we need to do some tests to understand whether
it is ok for your child to take part. In order to do this we will ask your child to complete
the following tests and/or questionnaires. The screening and/or baseline tests will
involve the following activities:
[INSERT the details of the screening or baseline assessments to be used]
[FOR QUESTIONNAIRE]
Your child will be asked to complete a number of [INSERT online or paper based]
questionnaires, which will ask questions about [INSERT the nature of the questions to
be asked]. We expect this activity to take up to [INSERT the time commitment
required].
[FOR INTERVIEW]
HC Number:
Version dated: Day Month Year
Page 2 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
Your child will be asked to participate in an interview that will take approximately
[INSERT time commitment required]. During the interview a member of the research
team will ask your child questions about the [INSERT the nature of the questions that
will be asked]. With your permission we would like to digitially record the interview
using an [INSERT audio tape/videotape/photograph]. The interviews will take place in
the following location:
[INSERT Location Details]
[FOR OBSERVATION]
We would like to observe your child completing [INSERT the nature of the observations
that will be conducted]. We expect this activity will take place over the course of
[INSERT the time commitment required] at [INSERT the location where the
observations will take place]. We will record your child’s interactions during this
period by [INSERT the method that will be used to record the observations] .
[FOR ACCESS TO PERSONAL RECORDS]
With your permission we would like to gain access to your child’s[INSERT the type of
personal records that will be accessed] to collect information that tells us [INSERT the
nature of the information that will be collected.]
[REMOVE if not applicable - Example study task table]
Visit
#
Visit 1
Procedures



Location*
Visit
Length
Screening assessments
Interview
Personal Record review
Visit 2
Will there be any payment to participate in this project?
[Option 1]
You and your child will be reimbursed for any reasonable travel, parking, meals and
other expenses associated with the research study [INSERT describe the process for
how they will be reimbursed].
[OR]
[Option 2]
There are no costs associated with participating in this research study, nor will you and
your child be paid.
What are the possible benefits to participation?
We hope to use information we get from this research study to benefit others who
[INSERT realistic potential future benefits. Please do not overstate the benefits]
What will happen to information about my child?
HC Number:
Version dated: Day Month Year
Page 3 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
By signing the consent form you consent to the research team collecting and using
information about your child for the research study. We will keep your child’s data for
[INSERT storage period]. We will store information about your child at [INSERT
storage location/s]. Your child’s information will only be used for the purpose of this
research study and it will only be disclosed with your permission.
It is anticipated that the results of this research study will be published and/or
presented in a variety of forums. In any publication and/or presentation, information
will be provided in such a way that your child’s [INSERT one of the options below].
[OPTION 1: where participants will NOT BE IDENTIFIABLE in publications]:
research findings may be published, but you will not be individually identifiable in
these publications.
[OPTION 2: where it is intended to protect participants’ identities but there is a RISK
THEY WILL BE IDENTIFIABLE in publications e.g. studies that focus on a small and
specific cohort]:
research findings may be published. Although every effort will be made to protect your
child’s identity, there is a risk that your child might be identifiable in publications due
to the nature of the study and/or the results.
[OPTION 3: where participants will be given the opportunity to CHOOSE WHETHER
THEY ARE IDENTIFIED in publications]:
research findings may be published, but your child will not be identified in these
publications unless you agree by [INSERT instructions on how they can indicate their
preference].
[OPTION 4: where PARTICIPANTS WILL BE IDENTIFIED in publications e.g. oral
history]:
research findings may be published, and your child will be identified in these
publications if you decide to participate in this study.
You have the right to request access to the information about your child that is collected
and stored by the research team. You also have the right to request that any information
with which you or your child disagree be corrected. You can do this by contacting a
member of the research team.
[OPTION 5: where PARTICIPANTS AUDIOTAPED/VIDEOTAPED/PHOTOGRAPHED:]
The INSERT Audiotaped/Videotaped/Photographed] digital recordings are for the
purposes of the research study. After the INSERT interview/focus group] we will
INSERT transcribe OR delete OR transcribe and then delete] your child’s digital
recordings. We will keep your child’s digital recordings in the form of INSERT
transcription OR digital recording and transcription] for [INSERT storage period]. We
will store information about your child at [INSERT storage location/s]. Your child’s
HC Number:
Version dated: Day Month Year
Page 4 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
confidentiality will be ensured by [INSERT description of how confidentiality will be
ensured].
How and when will I find out what the results of the research study are?
You and your child have a right to receive feedback about the overall results of this
study. You can tell us that you wish to receive feedback by [INSERT a description of
how participants can indicate they are interested in receiving feedback].This feedback
will be in the form of [INSERT a description of the feedback that participants will be
provided with, ensuring it is appropriate for the audience e.g. a one page lay
summary].You will receive this feedback after the study is finished.
[INSERT, if applicable to your study, a statement about any PERSONALISED FEEDBACK
that participants are entitled to receive concerning their individual results in the study
(e.g. diagnostic procedures, clinical tests, intelligence or aptitude testing). Be sure to
distinguish between this type of feedback and the general group-based results described
above. Include any conditions associated with this feedback (e.g. that participants’
personal results will only be provided to them through a nominated clinician such as a
GP or psychologist) and explain when and how it will be provided.]
What if I want to withdraw my child from the research study?
If you decide to let your child take part in the research study and then change your
mind later, or they no longer wish to take part, you are free to withdraw them from the
study at any time. If you do withdraw, you will be asked to complete and sign the
‘Withdrawal of Consent Form’ which is provided at the end of this document.
Alternatively you can ring the research team and tell them you no longer want to
participate.
If you decide to withdraw your child from the research study, the researchers will not
collect additional information from your child.
[INSERT, if applicable to your study – ONE OR MORE of the following statements about
study data].
[For Interviews]
Your child is free to stop the interview at any time. Unless you say that you want us to
keep them, any recordings will be erased and the information your child has provided
will not be included in the study results. Your child may also refuse to answer any
questions that they do not wish to answer during the interview.
[For NON-ANONYMOUS questionnaire]
Your child’s questionnaire responses can be withdrawn after submission and will not be
included in the published results.
HC Number:
Version dated: Day Month Year
Page 5 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
[For ANONYMOUS questionnaire]
Your child’s questionnaire responses can be withdrawn any time before they have
submitted the questionnaire. Once they have submitted it, their responses cannot be
withdrawn because they are anonymous and therefore we will not be able to tell which
one is theirs.
[For FOCUS GROUP]
If your child takes part in a focus group, they are free to stop participating at any stage
or to refuse to answer any of the questions. However, it will not be possible to
withdraw their individual comments from our records once the group has started, as it
is a group discussion.
[For OTHER data that CAN BE WITHDRAWN]
If your child withdraws from the study, we will not collect any more information from
them. Please let us know at the time when they withdraw what you would like us to do
with the information we have collected about them up to that point. If you wish, their
information will be removed from our study records and will not be included in
publications, up to the point that we have analysed and published the results.
[For OTHER data that CANNOT BE WITHDRAWN]
If your child withdraws from the study, we will not collect any more information from
them. Any information that we have already collected, however, will be kept in our
study records and may be included in publications.
What should I do if I have further questions about my child’s involvement in the
research study?
The person you may need to contact will depend on the nature of your query. If you
want any further information concerning this project or if you have any problems which
may be related to your child’s involvement in the project, you can contact the following
member/s of the research team:
Research Team Contact
Name
Position
Telephone
Email
[INSERT
[INSERT
[INSERT
[INSERT
full name]
position title]
work telephone number]
work email address]
[INSERT if applicable]
If at any stage during the project your child becomes distressed or requires additional
support from someone not involved in the research please call:
Contact for feelings of distress
Name/Organisation
Position
HC Number:
Version dated: Day Month Year
[INSERT name/organisation]
[INSERT position title]
Page 6 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
Telephone
Email
[INSERT work telephone number]
[INSERT work email address]
What if I have a complaint or any concerns about the research study?
If you have any complaints about any aspect of the project, the way it is being
conducted, then you may contact:
Complaints Contact
Position
Telephone
Email
HC
Reference
Number
HC Number:
Version dated: Day Month Year
Human Research Ethics Coordinator
+ 61 2 9385 6222
humanethics@unsw.edu.au
[INSERT HC reference number]
Page 7 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
Consent Form – Parent/Guardian providing consent for their
child
Declaration by the Parent/Guardian

I have read the Participant Information Sheet or someone has read it to me in a
language that I understand;

I understand the purposes, study tasks and risks of the research described in the
project;

I have had an opportunity to ask questions and I am satisfied with the answers I have
received;

I freely agree to my child participating in this research study as described and
understand that I am free to withdraw them at any time during the project and
withdrawal will not affect my relationship with any of the named organisations and/or
research team members;

I understand that I will be given a signed copy of this document to keep;
Parent/Guardian Signature
Name of Child
(please print)
Name of Parent/Guardian
(please print)
Signature of Parent/Guardian
Date
Declaration by Researcher*
 I have given a verbal explanation of the research study, its study activities and risks and
I believe that the participant has understood that explanation.
Researcher Signature*
Name of Researcher (please
print)
Signature of Researcher
Date
+
An appropriately qualified member of the research team must provide the explanation
of, and information concerning the research study.
HC Number:
Version dated: Day Month Year
Page 8 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
Note: All parties signing the consent section must date their own signature.
HC Number:
Version dated: Day Month Year
Page 9 of 10
Parent/Guardian Participant Group:
[INSERT any other organisational letterhead and the name of
the School/Organisation/Centre]
PARENT/GUARDIAN INFORMATION STATEMENT AND CONSENT FORM
[INSERT Participant Group (if applicable)]
[INSERT Title of project]
[INSERT Chief Investigator Name]
Form for Withdrawal of Participation – Parent/Guardian
I wish to WITHDRAW my consent for my child to participate in the research proposal
described above and understand that such withdrawal WILL NOT affect their relationship
with The University of New South Wales, [other participating organisation[s] or other
professional(s)].
Parent/Guardian Signature
Name of Child
(please print)
Name of Parent/Guardian
(please print)
Signature of Parent/Guardian
Date
The section for Withdrawal of Participation should be forwarded to:
CI Name: [insert CI name]
Email: [insert work email address]
Phone: [insert work mobile number]
Postal Address: [insert work postal address]
HC Number:
Version dated: Day Month Year
Page 10 of 10
Parent/Guardian Participant Group: