Application for Approval by UK FTVS Ethics Committee

CHARLES UNIVERSITY

FACULTY OF PHYSICAL EDUCATION AND SPORT

José Martího 31, 162 52 Prague 6-Veleslavín

Application for Approval by UK FTVS Ethics Committee

of a research project, thesis, dissertation or seminar work involving human subjects

The title of a project:Fill in the name of your project (e.g. thetitle of your bachelor thesis)

Project form: research work / seminar / bachelor / master / PhD dissertation / PhDr dissertation / habilitation – select relevant option and delete the others

Period of realization of the project:Fill in month and year of implementation as planned (only future time)

Applicant:Name, surname, titles, workplace (UK FTVS + department)

Main researcher:Name, surname, titles, workplace (UK FTVS + department)

Workplace: Say where the research will take place

Co-researcher(s):Name, surname, title, workplace (UK FTVS + department)

Supervisor:Students should give supervisor’s name if it is a bachelor / master / PhD dissertation

Financial support:Give name of any financial support for the project (e.g. give the name of a grant)

Project description: Give a brief project description, aims and methods used. Give methods in detail in regard to the involvement of participants – i.e. try to stateclearly the type of study (e.g. observational cross-sectional study, observational longitudinalstudy, experiment, etc.) and describe in detail the method of data collection (e.g. laboratory tests, questionnaire, observation), so that it is clear what the participants will do. (However,itis not necessary to describe methods of data processing).

Characteristics of participants in the research: Supposed number of participants; their approximate age; if it is relevant for the research: health requirement for participation (do they have valid a health-check?), their experience with regard to the planned activities (e.g. performance sport athletes), contraindications (i.e. who cannot be included in the project?), say who will select the participants based on the contraindications, etc.

Ensuring safety within the research: Will the research put anyone at risk? It is necessary to state risks and ways of risk minimization, to describe precisely how safety is ensured – in line with the given research: e.g. a doctor’s presence, names of qualified personnel who are going to be present during the research, and their qualification(s).

If using invasive methods, it is necessary to provide reasons for their use, and assurance of qualified provision (e.g. blood sampling will be carried out by a qualified medic). If using non-invasive methods, it is necessary to state that non-invasive methods are used.

Ethical aspects of the research: Give reasons for research requiring theparticipation of vulnerable groups or individuals (e.g. participation of children, pregnant or breast-feeding women, people with a mental illness, prisoners, members of vulnerable communities, etc.),and explain the benefit of the research for this kind of vulnerable group as a whole, especially regarding health benefits; or state that the participants are adults and non-vulnerable.

Personal data protection (e.g. the gained data will be processed and safely retained in ananonymised form and published in a bachelor (etc.) thesis, possibly also in journals, monographs, and presented at conferences, possibly also used in further research at UK FTVS. After the anonymization the personal data will be deleted).

Taking photographs/videos of the participants (e.g. anonymisation of persons on the photographs will be done by blurring their faces or parts of the body or characteristics that could lead to identification of the person. Non-anonymised photographs will be deleted after the end of the research).

I shall ensure to the maximum extent possible that the research data will not be misused.

Informed Consent: attached(You must attach a draft of the Informed Consent document – in a language that the subject can understand)

It is the duty of all participants of the research team to protect life, health, dignity, integrity, the right to self-determination, privacy and protection of the personal data of all research subjects, and to undertake all possible precautions. Responsibility for the protection of all research subjects lies on the researcher(s) and not on the research subjects themselves, even if they gave their consent toparticipation in the research. All participants of the research teammust take into consideration ethical, legal and regulative norms and standards of research involving human subjects applicable not only in the Czech Republic but also internationally.

I confirm that this project description corresponds to the plan of the project and, in case of any change, especially of the methods used in the project, I will inform the UK FTVS Ethics Committee, which may require a re-submission of the application form.

In Prague, givedate of sending the last version by e-mailApplicant’s signature:

Approval ofUK FTVS Ethics Committee

The Committee: Chair: doc. PhDr. Irena Parry Martínková, Ph.D.

Members: prof. PhDr. Pavel Slepička, DrSc.

doc. MUDr. Jan Heller, CSc.

PhDr. Pavel Hráský, Ph.D.

Mgr. Eva Prokešová, Ph.D.

MUDr. Simona Majorová

The research project was approved by UK FTVS Ethics Committee under the registration number: ………………..

Date of approval: ……………….

UK FTVS Ethics Committee reviewed the submitted researchproject and found no contradictions with valid principles, regulations and international guidelinesfor carrying out research involving human subjects.

The applicanthas met the necessary requirements for receiving approval of UK FTVS Ethics Committee.

Stamp ofUK FTVS Signature of the Chair of

UK FTVS Ethics Committee