FNS Core Nutrition Messages Concept Testing

Attachment F: Confidentiality Statement for Parents of Children (8-10 years old)

USDA Food Guidance System

CONFIDENTIALITY AGREEMENT

I, __________________________(print name), and my child, _____________________________ (print name) agree to keep all information shown and discussed during the USDA focus group in which my child is participating in the strictest confidence.

I agree not to discuss, publish, or otherwise divulge any information I am exposed to, in whole or in part, in any manner or form through my child’s participation.

My child’s comments will be kept confidential and only used for research purposes. His or her name, as well as my name, will not be divulged in any reports of this focus group.

Signed:___________________________ Dated: ____________________

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