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Participant's Name
Parent/Guardian Name
Address
How Will My Information Be Used?
The information that you provide about you and your family will be used to [describe the purpose of collecting the information e.g. gain an insight into services and what is important to families].
Consent
I have read the information above and have had an opportunity to ask questions about the [research / activity] and how my information will be used. I understand the purpose of the [research /activity] and what my participation involves. I agree to take part in [describe what involvement the individual will have e.g. an interview] and for the information I provide to be shared with the [area] Partnership agencies and this in turn allows services that I use to share information about me and my family for the purpose of this [research / activity]. I understand that I need to inform the other members of my family that I have given consent which will allow them to opt out if they wish. I understand that anonymized [information / research] about me and my family may be published within the [project report / relevant document], which may be published online and that published material from this [project / report] may be used and distributed for training and service design and development. I know that my participation is voluntary and that I can choose to withdraw from the research at any point.
Clear Signature

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What’s in the General Consent Form?

With our consent form template, you can collect participant names, addresses, and emergency contact numbers. We’ve also included a consent agreement field alongside a sign and date box.

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Getting a Signature on Your Form

On this consent form, we used the WPForms Signature addon to capture a picture of your visitor’s signature. The image will be linked in your form notification so that you can save it or refer to it as needed.

To use our Signature addon, you’ll need the WPForms Pro or Elite license.