Parental Letter of Consent with Assent included (grades 3-5)
IRB Protocol Number:
Title of Research Study:
Summary Statement (include activities, risks and benefits): This research is to learn how your children play with instruments in different settings and groups. It will involve your child playing different musical instruments, making music in a group, asking your child about the experience through interviews and surveys, and making an audio/video recording of the experience. It will require using audio and video recordings of your child that will mean their image will be used for publication. A separate consent will need to be signed for this purpose. The primary risk is that your child may be uncomfortable being audio or video-recorded or working in groups. There is no specific benefit from participation.
Dear Parent/ Guardian and Student,
My name is XX and I am a Professor in the XX Department at UMass Lowell. I am conducting a research study on how children play with musical instruments. The purpose of this research is to find out what happens when we put children into a group and ask them to work together to make music.
We are asking your permission for your child to participate in this research. Participation is completely voluntary, and if you agree, we will also ask your child for their consent to participate as well. The research will involve the following activities with your child:
a) playing with unfamiliar musical instruments.
b) making up music together in a group.
c) being interviewed and asked questions about how they made this music. The interview will take place at [location] and will take place right after your child is finished playing with the instruments in [location].
d) verbally responding to questions on a survey. The questions will ask for information about your child (like age and the instrument they play) and also about their experiences playing with the instruments. The survey will take about 5 minutes to complete and will be given right after your child plays with the instruments.
e) making a video and audio recording of your children playing the music and talking to us during the interview
The video and audio recordings we make of your children playing with the instruments will be used for research purposes and we may show the video at research conferences in the future so we also need you to sign a separate release form to authorize the use of your child’s image for publication.
The risk to your child from participation in this research is minimal. However, your child may feel uncomfortable being filmed while playing with the instruments as part of their composition curriculum, self-conscious about improvising with their peers, pressure to participate or uncomfortable answering interview or survey questions. You or your child may opt out of this research at any time by sending an email to r speaking directly to the researcher at 978-934-xxxx.
If you have any questions or concerns regarding this study, please feel free to contact me. Thank you for your support!
Name, Principal Investigator, Name of Department
and Phone 978-934-xxxx
Parental Acknowledgment:
I understand the potential risks and/or discomforts to my child that have been described in this document and by the researcher. By signing below, I am indicating that I have read this document, had the opportunity to discuss any concerns and ask questions about the research, and understand the risks and consequences to my child in participating in this study.
Please check an appropriate box for each activity:
☐ I allow the researcher to observe and take notes about my child.
☐ I DO NOT allow the researcher to observe and take notes about my child.
☐ I allow the researcher to interview my child.
☐ I DO NOT allow the researcher to interview my child.
☐ I allow the researcher to ask my child to fill out a survey.
☐ I DO NOT allow the researcher to ask my child to fill out a survey.
☐ I allow my child to be audio/video-recorded.
☐ I DO NOT allow my child to be audio/video-recorded.
Parent/Guardian Name (printed):
Parent/Guardian Signature: Date:
Name of my child(printed):
Student Assent or Agreement to Participate:
I understand that my teacher is doing a research study about how children make up music in a group.
I know that my parents have agreed to let me participate in the research study but that I can choose to participate or not participate AT ANY TIME.
I understand that choosing to participate or not participate will not affect my participation in String Project in any way.
YES, I want to participate
NO, I do not want to participate
My Name (printed): Date:
I agree to be audio/video-recorded (check one)YES_____ or NO______