Parent Focus Group - Consent

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

PARENT FOCUS GROUP CONSENT

The Presidential Youth Fitness Program (PYFP) has partnered with the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and ICF International to conduct an evaluation of the (PYFP). The goal of this focus group is to understand your perspectives, experiences, and insights about PE and physical activity programs at your child’s school, particularly the Presidential Youth Fitness Program. This focus group should take about 60 minutes, and you can refuse to answer a question or end your participation in the focus group at any time. We will maintain confidentiality throughout the entire project and your names will not be associated with anything you say in any of the reports or documents resulting from this evaluation.

Taking part in the focus group will cause little or no risk. You will receive no immediate benefit for participating in the focus group other than the knowledge of knowing you are helping to contribute information that will ultimately be used for the purposes of program improvement. The questions will focus on your opinions and experiences, and there are no right or wrong answers. If the focus groups occur outside of school hours you will receive a $15 gift card in appreciation for your participation.

I have read this form and know what the PYFP Evaluation is about.

[ ] Yes, I agree to participate in the Parent Focus Group

[ ] No, I do not wish to participate in the Parent Focus Groups

Signature: ________________________________ Date: _____________________

Print Name: ___________________________________________________________

If you have any questions or concerns, please contact Isabela R. Lucas, Project Manager for the PYFP Evaluation, at ICF International: [email protected] or 404-592-2155.