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Sample Student Assent Form for Primary 1 to Primary 3 Students
THE UNIVERSITY OF HONG KONG
Dear Students,
We are a team of researchers from the , The University of Hong Kong and are now conducting a study titled . We hope to spend some time with you to let you know more about details of this project.
We have obtained written consent from your parent/guardian earlier to let you join this project. However, your decision is also very important to us. If you agree to join this project, you will be asked to . The will not cause any discomfort. For the video recording with groups, you will be outside the camera view or having the image blurred if you do not agree to be video-recorded. It will last for approximately <10> minutes. [Explain how long will the data containing personal identifiers be kept after publication of first paper, and whether personal identifiers will be removed for long term retention of the research data. Please delete this paragraph if the data to be collected does not contain personal identifier.]. If you have any questions about the research, please feel free to contact [Title & Name of the principal investigator (telephone number (for studies conducted in Hong Kong)/email address (for overseas studies))]. If you have any further question, please raise it now. Thank you for your support.
If you agree to take part in this project, please put a tick in the following box and sign your name besides it.
( I agree to participate in this project.
I ** agree / do not agree to the [video-recording / audio-recording] during the procedure.
[Please delete this sentence if the process does not involve video-recording and audio-recording.]
I ** wish / do not wish to be identified. (if the procedure will involve personal interview)
(** Please delete as appropriate.)
Signature:__________________
OR
If you do not agree to take part in this project, please put a tick in the following box and sign your name besides it.
( I do not agree to participate in this project.
Signature:__________________
Student Name:________________ Class: ______________ Date:_______________
HREC Reference Number: [The reference number is indicated in the letter of approval for ethical clearance issued by the Human Research Ethics Committee (HREC).]
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