Parent consent for child to participate in online short games to study how children learn
We are excited to announce that you no longer need to be in the San Diego area to participate in our studies! We are now offering studies that can be completed online, and at times that are convenient for you!

Learn more here: https://madlab.ucsd.edu/experiments
Email us at: madlab@ucsd.edu
Please fill out this form before participating in the study. If you have any questions, contact our researchers at madlab@ucsd.edu.

The full PDF of this form can be found at https://madlab.ucsd.edu/pdfs/Parent_Permission_Form_Online.pdf

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Parent Consent for Child to Participate in Research:
The purpose of this form is to provide you with information about taking part in a research study. If you have any questions, please ask us โ€“ you can call us at 858-534-7713 or email us at MaDlab@ucsd.edu.

Taking part in this study is up to you. If you decide to allow your child to take part in this study, we will ask you to sign this form. Our research team is the Mind and Development Lab, a member of the Kid Science Labs at UCSD. The person in charge of this study is Prof. Adena Schachner โ€“ you can reach her at schachner@ucsd.edu. Please print or save a copy of this document for your records.

๐—ช๐—ต๐˜† ๐—ถ๐˜€ ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜† ๐—ฏ๐—ฒ๐—ถ๐—ป๐—ด ๐—ฑ๐—ผ๐—ป๐—ฒ?
Prof. Adena Schachner is conducting this study to find out more about childrenโ€™s developing understanding of the social and physical world. The study explores how children reason about social things, like faces or actions, and non-social things, like objects or natural events. How do children learn the ideas they need to understand actions, objects, and events? How do children learn about the individual people and objects they see?
Your child has been asked to participate in this study because we are currently investigating development at your childโ€™s age level. Over several years, this study will include children between the age of 3 months and 18 years, and approximately 8,000 participating families.

๐—›๐—ผ๐˜„ ๐—น๐—ผ๐—ป๐—ด ๐˜„๐—ถ๐—น๐—น ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜† ๐˜๐—ฎ๐—ธ๐—ฒ?
Your childโ€™s participation will involve just one session, which may be very short (for example, 10 minutes), no longer than 30 minutes.

๐—ช๐—ต๐—ฎ๐˜ ๐˜„๐—ถ๐—น๐—น ๐—ต๐—ฎ๐—ฝ๐—ฝ๐—ฒ๐—ป ๐—ถ๐—ณ ๐—บ๐˜† ๐—ฐ๐—ต๐—ถ๐—น๐—ฑ ๐˜๐—ฎ๐—ธ๐—ฒ๐˜€ ๐—ฝ๐—ฎ๐—ฟ๐˜ ๐—ถ๐—ป ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†?
In this research study, your child will participate in one or more short activities designed for children of their age. These activities will take place at your computer or mobile device with a webcam, from the comfort of your own home or location of choice.
Your child may join a video call with a trained researcher, and/or listen to a short story, see a short puppet show or video, or play simple games. For example, children may be asked to sort toys into categories, or interact with an age-appropriate game on the screen. The researcher may ask your child questions about the story or game. Older children will take part in similar games, designed for their age level: for example, they may be asked to read a story themselves instead of hearing it read to them. Alternatively, you may be asked to interact with your child (for example, by singing, speaking, or playing with toys).

๐—ฆ๐˜๐˜‚๐—ฑ๐˜† ๐—ฃ๐—ฎ๐—ฟ๐˜๐—ถ๐—ฐ๐—ถ๐—ฝ๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ฎ๐—ป๐—ฑ ๐—ช๐—ถ๐˜๐—ต๐—ฑ๐—ฟ๐—ฎ๐˜„๐—ฎ๐—น
Taking part in this study is your and your childโ€™s choice. Your child is free to not take part or to withdraw at any time for any reason, and you are free to withdraw your child at any time for any reason. No matter what you decide, there will be no penalty or loss of any benefit to which you and your child are entitled. If you decide to withdraw your child from this study or your child decides to withdraw from this study, the information that you have already provided will be kept confidential. You may choose to withdraw your child or your child may withdraw by telling the researcher that you or your child wish to stop participation in this study. Additionally, the researcher may withdraw your child from participating if the researcher believes that it is in the best interests of the child or the study.

๐—ช๐—ต๐—ฎ๐˜ ๐—ฎ๐—ฟ๐—ฒ ๐˜๐—ต๐—ฒ ๐—ฟ๐—ถ๐˜€๐—ธ๐˜€ ๐—ผ๐—ณ ๐˜๐—ฎ๐—ธ๐—ถ๐—ป๐—ด ๐—ฝ๐—ฎ๐—ฟ๐˜ ๐—ถ๐—ป ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†?
The study does not involve any risks or discomforts beyond those experienced in everyday life. There is a risk of your child becoming bored, but we try to avoid this by designing all tasks to be engaging to children, and keeping sessions short in length. As with any study, there is a risk of loss of confidentiality, so we take many steps to ensure that the records of this study and your childโ€™s participation are kept confidential. Since this is an investigational study there may be some unknown risks that are currently unforeseeable. You will be informed of any significant new findings.

๐—›๐—ผ๐˜„ ๐˜„๐—ถ๐—น๐—น ๐˜†๐—ผ๐˜‚ ๐—ธ๐—ฒ๐—ฒ๐—ฝ ๐—บ๐˜† ๐—ฐ๐—ต๐—ถ๐—น๐—ฑโ€™๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜† ๐—ฟ๐—ฒ๐—ฐ๐—ผ๐—ฟ๐—ฑ๐˜€ ๐—ฐ๐—ผ๐—ป๐—ณ๐—ถ๐—ฑ๐—ฒ๐—ป๐˜๐—ถ๐—ฎ๐—น?
We will keep the records of this study confidential by storing them on our secure and password protected server, on a password-protected computer in a locked room, and/or in a locked cabinet; by identifying participants by ID codes rather than names; and by only allowing laboratory personnel access to research materials. Publications and conference presentations of the data will not identify individuals and will present results of the group as a whole. Signed consent forms will be kept separate from the research data.

๐—”๐—ฟ๐—ฒ ๐˜๐—ต๐—ฒ๐—ฟ๐—ฒ ๐—ฎ๐—ป๐˜† ๐—ฏ๐—ฒ๐—ป๐—ฒ๐—ณ๐—ถ๐˜๐˜€ ๐—ผ๐—ณ ๐—ฏ๐—ฒ๐—ถ๐—ป๐—ด ๐—ถ๐—ป ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†?
Children typically enjoy participation, and you as a parent may enjoy learning about this research on childrenโ€™s development. Your childโ€™s participation will increase knowledge of how children learn.

๐—ช๐—ถ๐—น๐—น ๐˜„๐—ฒ ๐—ฏ๐—ฒ ๐—ฝ๐—ฎ๐—ถ๐—ฑ ๐—ณ๐—ผ๐—ฟ ๐˜๐—ฎ๐—ธ๐—ถ๐—ป๐—ด ๐—ฝ๐—ฎ๐—ฟ๐˜ ๐—ถ๐—ป ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†?
You will receive an online gift certificate (e.g. $5 USD Amazon gift card), which may be used to purchase a small gift for your child for participating in this research.

๐—ช๐—ต๐—ฎ๐˜ ๐˜„๐—ถ๐—น๐—น ๐—ถ๐˜ ๐—ฐ๐—ผ๐˜€๐˜ ๐˜‚๐˜€ ๐˜๐—ผ ๐˜๐—ฎ๐—ธ๐—ฒ ๐—ฝ๐—ฎ๐—ฟ๐˜ ๐—ถ๐—ป ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†?
Aside from time, there are no known costs to you for participating in this research study.

๐—œ๐—ณ ๐˜„๐—ฒ ๐—ต๐—ฎ๐˜ƒ๐—ฒ ๐—ฎ๐—ป๐˜† ๐—พ๐˜‚๐—ฒ๐˜€๐˜๐—ถ๐—ผ๐—ป๐˜€ ๐—ผ๐—ฟ ๐—ฐ๐—ผ๐—ป๐—ฐ๐—ฒ๐—ฟ๐—ป๐˜€ ๐—ฎ๐—ฏ๐—ผ๐˜‚๐˜ ๐˜๐—ต๐—ถ๐˜€ ๐˜€๐˜๐˜‚๐—ฑ๐˜†, ๐˜„๐—ต๐—ผ ๐—ฐ๐—ฎ๐—ป ๐—œ ๐˜๐—ฎ๐—น๐—ธ ๐˜๐—ผ?
If you or your child have questions or concerns regarding this research, either now or at any time in the future, please feel free to contact our research team (858-534-7713 or MaDlab@ucsd.edu) or Prof. Adena Schachner (schachner@ucsd.edu). You may also obtain information about your childโ€™s rights as a research participant by contacting the Human Research Protections Program Office at 858-246-4777.
Check below to allow your child to participate in the study *
๐—ฆ๐˜๐—ฎ๐˜๐—ฒ๐—บ๐—ฒ๐—ป๐˜ ๐—ผ๐—ณ ๐—ฐ๐—ผ๐—ป๐˜€๐—ฒ๐—ป๐˜: I have read the information in this consent form, including risks and possible benefits. I have been given an opportunity to ask questions, and my questions have been answered to my satisfaction. I have been given a copy of this form, or given the opportunity to print or save a copy of this electronic form (at https://madlab.ucsd.edu/pdfs/Parent_Permission_Form_Online.pdf).                                                                                        
Required
Name of parent/guardian *
Today's Date *
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Child's Name *
Child's Date of Birth *
MM
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DD
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Child's Gender *
Please tell us a bit more about your child in the questions below:
Where are you and your child participating from? (Country, Time Zone)
Example: USA, PST
All of our activities are currently conducted in English. Is English your child's first language?
Clear selection
Do you think your child will understand an age-appropriate game or video in English?
Clear selection
Does your child have auditory impairments (hearing problems)?
Clear selection
(Optional) Please explain any auditory impairments:
Does your child have (uncorrected) visual impairments?
Clear selection
(Optional) Please explain any visual impairments:
For Children Under age 3 years
Was your child born at full-term, or pre-term?
Clear selection
If you selected pre-term above, what was the weeks of gestation at birth?
Number in weeks (Example: 32 weeks)
Video/Audio Recording
We would like to record the study session for our records (for example, using your computerโ€™s webcam), as a video, still images, or audio. In a video recording or in an image, it will be possible to identify your child or yourself; however we will keep the recordings confidential and only approved study staff will be able to see them. We will store the recordings on our secure and password protected server, on a password-protected computer in a locked room, and/or in a locked cabinet, and label them with a code instead of your name. The recordings will be securely stored for ten years, and then deleted.
Do you agree to let us videotape your child during this study? If so, how? *
Yes
No
Video and Audio (preferred)
Audio-only
Still images from the video
Email for receiving online gift certificate
To thank you and your child, we will send you an online gift card. This email will only be used to send you the gift card.                        ๐—ฃ๐—น๐—ฒ๐—ฎ๐˜€๐—ฒ ๐—ฝ๐—ฟ๐—ผ๐˜ƒ๐—ถ๐—ฑ๐—ฒ ๐˜๐—ต๐—ฒ ๐—ฒ๐—บ๐—ฎ๐—ถ๐—น ๐—ฎ๐—ฑ๐—ฑ๐—ฟ๐—ฒ๐˜€๐˜€ ๐˜๐—ต๐—ฎ๐˜ ๐˜†๐—ผ๐˜‚ ๐˜„๐—ผ๐˜‚๐—น๐—ฑ ๐—น๐—ถ๐—ธ๐—ฒ ๐˜‚๐˜€ ๐˜๐—ผ ๐˜€๐—ฒ๐—ป๐—ฑ ๐˜๐—ต๐—ฒ ๐—ด๐—ถ๐—ณ๐˜ ๐—ฐ๐—ฎ๐—ฟ๐—ฑ ๐˜๐—ผ:
Future contact
Would you like to be contacted about future opportunities for your child to participate in research studies with the Kid Science Labs at UC San Diego? By providing information, you are not committing to participate in other studies โ€“ weโ€™ll just ask you if youโ€™re interested, when a new study is available.
Future Contact
Would you like to be contacted about future opportunities for your child to participate in research studies with the Kid Science Labs at UC San Diego?                                                                                                                                                                                  By providing information, you are not committing to participate in other studies โ€“ weโ€™ll just ask you if youโ€™re interested, when a new study is available.                                                                                                                                                                                         ๐—œ๐—ณ ๐˜†๐—ผ๐˜‚ ๐˜๐—ต๐—ถ๐—ป๐—ธ ๐˜†๐—ผ๐˜‚ ๐—บ๐—ถ๐—ด๐—ต๐˜ ๐—ฏ๐—ฒ ๐—ถ๐—ป๐˜๐—ฒ๐—ฟ๐—ฒ๐˜€๐˜๐—ฒ๐—ฑ, ๐—ฝ๐—น๐—ฒ๐—ฎ๐˜€๐—ฒ ๐—ฐ๐—ต๐—ฒ๐—ฐ๐—ธ ๐˜๐—ต๐—ฒ ๐—ฏ๐—ผ๐˜… ๐—ฏ๐—ฒ๐—น๐—ผ๐˜„:                                      
If you are interested in being contacted about future studies, please provide your email address:
If your child has any siblings who you would like to have participate in future studies, please list their names and birthdates here:
Name (Birthdate in month/date/year); Example: Jane Doe (12/31/2010)
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