Appendix IV – Free and Informed Consent Form
I have read and understood the preceding pages of this Information Sheet and Free and Informed Consent form. The research procedures mentioned above have been explained to me and all of my questions have been answered to my satisfaction. I have been informed that I can withdraw from the study at any time without penalty and that, if I choose to do so, any data collected as a result of my participation will be destroyed. The potential discomforts that I might experience because I have participated in the study have been explained to me. I also understand the potential benefits of being a part of this study.
I know that I may ask now, or at any time in the future, any questions I have about the study. I have been assured that the records, transcripts, and tapes related to this study will be kept confidential to the limits of the law. I have also been assured that no information will be released or printed or made public that would disclose my personal identity unless I give permission for that to happen.
I hereby consent to participate in the interview
Printed Name of Participant:
Signature of Participant:
Date:
I hereby consent to having my interview recorded
Signature of Participant:
Date:
Signature of Principal Investigator:
Date:
Please Note: This research has been reviewed by the Human Participants in Research Committee, York University’s Ethics Review Board, and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines and the York Senate Policy on research ethics. If you have any questions about this process, or about your rights as a participant in the study, please contact:
Ms. Alison Collins-Mrakas - Manager, Research Ethics,
- York University mail: 277 York Lanes, York University, Toronto, ON, M3J 1P3, Canada
- Telephone: +1-416-736-5914
- Email Alison Collins-Mrakas
If you would like to contact the Human Participants in Research Committee, please send your correspondence care of Ms Collins-Mrakas at the above regular mail or email address.