Customize the Research Consent Form Template

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Name of Project

Participant's Name

First

Last

Parent/Guardian Name

First

Last

Parent/Guardian Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact Number

How Will My Information Be Used?

Please tick the box to agree.

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

Please tick the box to agree.

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.

Signature

Date

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This template includes features available in WPForms Pro. Compare Plans

Use this research consent form to collect permission from individuals to take part in a study. The form’s purpose is to outline the study, detail the rights of a participant, and then a signature to the agreement of the terms.

Use the research consent form template below and fully customize it to fit your research needs:

Can I Make My Own Consent Form?

Yes. If you’re running a research project, making your own form is a great way to get exactly the consent you need.

WPForms makes it easy to adjust the fields, questions, and terms so that your form is completely unique to your own research project.

The information that you need will largely depend on your project, but we recommend that you include information like:

The purpose of your research project
How personal data will be stored or used
How long you’ll need people to be involved in the research

WPForms makes it easy to drag new fields onto your form, remove fields you don’t need, and adjust the notification settings.

Our form templates let you create any kind of WordPress form in a few clicks.

You can select any template to view the demo and try it out. If it works for you, you can import it and publish it in minutes. Each WPForms template is fully customizable too. Our drag and drop form builder makes it easy to adapt any template to fits your business’ needs. When you use our form templates, you can easily: