17%

‘F-Words for child development’ framework
—— Questionnaire For Families

Questions marked with a * are required

I have read and understood the Information Leaflet about this research project. The information has been fully explained to me and I have been able to ask questions, all of which have been answered to my satisfaction.

Yes

No

I understand that participation in this project is voluntary and I will not be identifiable in any way.

Yes

No

I have been assured that information about me will be kept private and confidential.

Yes

No

I consent to take part in this research study having been fully informed of the risks, benefits and alternatives.

Yes

No

I give informed explicit consent to have my anonymous data processed as part of this research study.

Yes

No

Storage and Future Use of Information

(Please choose option A or B)

Option A: I give permission for my anonymous data to be stored for possible future research related to the current study without further consent being required but only if the research is approved by a Research Ethics Committee.

Option B: I request that all my data collected for this study can no longer be used by researchers in the future and that it be destroyed.

I confirm that I am a family member of a children with disability in Ireland.

Yes

No

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