Youth Assent Form

Appendix E3

Youth Assent Form

Project: “Formative Research of Adults’ and Childrens’ views Related to Promotion of Healthy Food Choices”

Phases 1 or 2

Youth Assent Form

The project information will be presented and explained verbally to parents and children so that it is clear to all participants before the focus groups begin. Also, the children will receive copies to read and sign after the explanation and prior to beginning the focus groups.

We have asked you to take part in a group talk. This is a research project. You will be with other people your age. It will be about families and food. Your ideas will help us make ads. These ads may help families eat healthy foods.

You have your parent’s permission.

The talk will take about 2 hours. An adult expert will lead it.

First you will get to know each other a little bit. Then you will be asked for your ideas.

After, you will get $25.

We do not know of any risks to you by taking part.

You will be sharing your thoughts and ideas.

You may think that it is fun.

If you have questions, please ask your parents or the talk leader.

You do not have to do this. If you do take part, you do not have to answer any questions you don’t want to. You can leave the group at any time.

We will audiotape and videotape the talk. Some people will listen to your ideas. Others may watch or listen to the tapes later. We do this to make sure that the written report is right.

Youth Assent

I agree to take part in this group talk. I have read the Project Information. I understand that the group will talk about foods families eat. I also agree to be audio- and videotaped and observed.

Child’s Signature: __________________________________________

Child’s Name (please print): ____________________________________________

Date: ___________