CONSENT FORM

HSR #17-18-179

 

9 February 2018

 

Dear potential participant,

 

My name is Zac Johnson. I am a professor at California State University, Fullerton.

 

I am conducting a study to understand parent’s perceptions of traumatic brain injuries (e.g.,, concussions and sub-concussive blows) and youth football. You’ll be asked to answer a series of questions regarding your perception of football participation. In order to participate you must be 18 years old or older and currently have a child under the age of 18.

 

There are no known risks associated with participation in this study. Your participation will involve taking this questionnaire which you should be able to complete in about 15 minutes.  There are no direct benefits for participating in this study.

 

If you voluntarily choose to participate, please complete the following questionnaire. Read each statement carefully and respond by supplying the answer that best represents your experience. If you are unable to answer a question, or feel uncomfortable answering a question, you may leave the blank empty. There is neither a right nor a wrong answer to any question. You may stop at any time without fear of penalty. Do not provide any identification within the questionnaire. Your involvement within the study will be kept confidential. 

 

Results from this study may be published, but identifying information will be reported in group format. No names or personally identifying information will be included for publication. Your responses will be grouped together with others in order to answer the proposed research questions. Research records will be kept confidential to the extent allowed by law.  Data will be stored in a locked private office, on a password secured computer, for up to five years and only the primary investigator will have access to it.

 

Your participation is voluntary and you are free to withdraw from participation at any time without suffering penalty or loss of benefits or services you may otherwise be entitled to. 

 

I have no conflict of interest financial or otherwise in the outcome of this research.

 

If you would like more information about this research project, please feel free to contact me at either (657)278-3104 or zjohnson@fullerton.edu. If you have questions about the rights of human research participants contact the CSUF IRB Office at (657) 278-7719 or irb@fullerton.edu.

 

I have carefully read and/or I have had the terms used in this consent form and their significance explained to me.  By completing the attached questionnaire, I agree that I am at least 18 years of age and agree to participate in this project. 

 

 

Sincerely,

 

Zac Johnson
Human Communication Studies