CONSENT FORM FOR PARTICIPATION IN RESEARCH

(Focus Group)

Insert Project title here

I …......

being over the age of 18 years, hereby consent to participate as requested in the focus group for the research project with the title listed above.

1.  I have read the information provided.

2.  Details of procedures and any risks have been explained to my satisfaction.

3.  I agree to audio/video recording of my information and participation.
(Note to Researcher - delete this statement (or audio or video) if not relevant to your research)

4. I am aware that I should retain a copy of the Information Sheet and Consent Form for future reference.

5. I understand that: (Note to Applicant - delete irrelevant dot points listed below)

·  I may not directly benefit from taking part in this research.

·  Participation is entirely voluntary and I am free to withdraw from the project at any time; and am free to decline to answer particular questions.

·  While I can withdraw from participation at any time I cannot withdraw the information I have provided or ask that the recording be stopped.

·  While no identifying information will be published, due to the nature of focus groups anonymity cannot be guaranteed.

·  Although participation will not be anonymous, I should protect the identity of participants and confidentiality of all discussions that occur within the group to minimise risks to participants.

·  Whether I participate or not, or withdraw after participating, will have no effect on any treatment or service that is being provided to me.
(Note to Researcher - This statement only applies to clients of a service (e.g, clients of a health service). Delete this statement if not applicable to participants to be recruited)

·  Whether I participate or not, or withdraw after participating, will have no effect on my progress in my course of study, or results gained.
(Note to Researcher - This statement only applies to students. Delete statement if not applicable to participants to be recruited)

·  Even though information provided will be treated with the strictest confidence, disclosure of illegal activities will not be safe from legal search and seizure.
(Note to Researcher – if there is no possibility that illegal activities may be disclosed then this point can be deleted)

·  Even though information provided will be treated with the strictest confidence by the researcher(s) that, as a mandated reporter, disclosure of illegal activities (e.g, child neglect and/or abuse) will need to be reported by the researcher to the relevant authorities.
(Note to Researcher – if the researcher is not a mandated reporter, the point above should be deleted.

6. I have had the opportunity to discuss taking part in this research with a family member or friend.
(Note to Researcher – this point is more relevant to say, participants from a vulnerable population (e.g, children, people with cognitive impairment etc). Delete this point if you don’t think it is relevant to the participant group(s) to be recruited)

Participant’s name………………………………………………..…….…………………...

Participant’s signature……………………………………………Date…………………...

I, the researcher certify that I have explained the study to the volunteer and consider that she/he understands what is involved and freely consents to participation.

Researcher’s name………………………………….……………………......

Researcher’s signature………………………………..…………Date…………...………

NB: Two signed copies should be obtained. .

This research project has been approved by the Flinders University Social and Behavioural Research Ethics Committee (Project number INSERT PROJECT No. here following approval). For more information regarding ethical approval of the project please contact the Executive Officer on (08) 8201 3116 or