Focus Group Consent Form

Attachment J. Focus Group Consent Form

Model Aquatic Health Code (MAHC) Use and Implementation Focus Group
Please read and sign this sheet before you attend the focus group
Thank you for accepting our invitation to participate in this focus group. Your participation will help us
understand how the MAHC is meeting the needs of recreational water programs across state, territorial,
local, and tribal health departments in the United States.
The focus group will be observed and recorded. The audio will then be transcribed anonymously for
analysis. These transcripts will be the property of CDC. We will not use your voice or image in any public
media without your written consent.
This information will not be linked with your name in any way and will not be used for anything except
this project. All information from this discussion will be summarized anonymously.
We value your opinions and reactions and hope you will participate fully and openly. You do not have to
respond to all questions.
By signing this page, you acknowledge that you understand, agree to, and consent to the above
statements before participating in the focus group.

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Sign
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Print Name
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Date