Att 3 - Consent forms

Attachment 3:

KnowledgePanel® Survey-Specific Online Consent Form: Obtaining Informed Consent from Parents & Legal Guardians for Conducting Survey with Teens Age 15 to 17

[FIRST SCREEN]

Dear Knowledge Networks panelist,

Your [INSERT CHILD’S AGE] year-old SON/DAUGHTER is invited to complete a survey being conducted by the Centers for Disease Control and Prevention. The survey will be on a variety of topics related to sexual health. It will take about 30 minutes for HIM/HER to complete. The “Sexual Health Communication” survey will be quite similar to the kinds of surveys your child has already been involved in as a KnowledgePanel Member. The potential risk to respondents from completing the survey is minimal. Some questions might make him or her feel uncomfortable, but they have the right to skip any questions they don't want to answer. Participation is completely voluntary.

[SECOND SCREEN]

As always, his or her identity will be unknown in all data resulting from the study. The researchers will not have access to any of your child’s identifying information (such as his or her name). All of the conditions and terms described in the "Knowledge Networks, Inc. Privacy & Terms of Use Policy" document that you received when you got your recruitment packet are in effect for this study. If you have questions about your child’s rights as a participant in this study, or are dissatisfied at any time with any aspect of the “Sexual Health Communication” survey, you may contact Knowledge Networks at (800) 782-6899.

[THIRD SCREEN]

We sent you a copy of the survey that your teenager would be invited to participate in. If you already reviewed the survey or do not wish to review it, please answer the question below now.  If you would like to review the survey, please come back to this survey to answer the question below.  

Do you give your consent to Knowledge Networks for your child to complete this survey?

Yes

No

KnowledgePanel® Survey-Specific Online Consent Form: Obtaining Informed Consent from Teen Research Subjects (Age 15 to 25)

[FIRST SCREEN]

You are invited to be part of a group of KnowledgePanel® Members in a study being sponsored by the Centers for Disease Control and Prevention. The survey will be on a variety of topics related to sexual health. It will take about 30 minutes for you to complete. The “Sexual Health Communication” will be quite similar to the kinds of surveys you have already been involved in as a KnowledgePanel Member.

[SECOND SCREEN]

The potential risk to respondents from completing the survey is minimal. Some questions are of a sensitive nature. However, you have the right to skip any questions you don't want to answer. There are no additional benefits from completing the survey.

[THIRD SCREEN]

In the “Sexual Health Communication” survey, participation is completely voluntary. You may withdraw your consent or discontinue participation at any time without penalty. As always, your identity will be unknown in all data resulting from the study. The researchers will not have access to any of your identifying information (such as your name). All of the conditions and terms described in the "Knowledge Networks, Inc. Privacy & Terms of Use Policy" document that you received when you got your recruitment packet are in effect for this study. If you have questions about your rights as a participant in this study, or are dissatisfied at any time with any aspect of the “Sexual Health Communication” survey, you may contact Knowledge Networks at (800) 782-6899.

[FOURTH SCREEN]

If you have read this form and have decided to agree to be an eligible participant, the “Sexual Health Communication” survey will follow.  Would you like to participate in this survey?

Yes

No

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Knowledge Networks Key Company Information, Past External Review, Confidentiality and
Privacy Protections for Panelists: Documentation for Human Subject Review Committees

© 2009