New York City Department of Education
Institutional Review Board
Parental Consent Form for Child Participation in a Research Study
Statement of Consent

Question Title

* I have read this consent form. The research study has been explained to me. I agree to let my child be in the research study described above.

A copy of this consent form will be provided to me after I sign it.

By signing this consent form, I have not given up any of the legal rights that I or my child would have if I or my child were not a participant in the study.

Question Title

* Please write your initials next to each choice you make below:

Question Title

* Please type your full name below to serve as your digital signature.

Question Title

* Please enter the date and time you have completed this form. 

Date
Time

Question Title

* Please type your email address below so we can email a copy of this consent form.

Thank you for completing the consent form.

T