Child Information Sheet and Assent Form

Study Title: The Educational and Social Implications of Sabong sa Kaka (Spider Derby) Among
Elementary Learners

Introduction
We want to tell you about a research study we are doing. A research study is a special way to
find out about something. We are trying to find out more about The Educational and Social
Implications of Sabong sa Kaka. You are being asked to join the study.

We invite you to participate in this study.

What will you have to do?

You are being asked to be part of this project. The project is about the implications of the game
to you. Your _________________________ [parents or legal guardian, if applicable] have
already been told about the project. Your accompanying parent / guardian will also sign a similar
form called as the Parent Informed Consent Form Please read this form and ask the researcher
any questions you have. It is your choice to be part of the project or not. The assent form
describes the research study and states that you have been explained the purpose and the
nature of the study to your satisfaction by the attending doctor and you are ready to follow the
study procedures.

Risks, discomforts & Side effects

There are no risks, discomforts, and side effects in conducting this study

Benefits
If you are in the study it may not help you to get better or benefit you. But we hope to learn
something that will help other people someday.

Confidentiality
The information collected about you during this study will be kept safely locked up. Nobody will
know it except the doctor doing the research. The doctor will not tell your friends or anyone else.
The information will only be accessed by the doctor the Ethics Committee and the Regulatory
authority. The study information about you will be given to your father/mother/guardian if required.

Right to refuse or withdraw

You do not have to be in this study, if you do not want to be. If you do not want to be in this study,
we will tell you what other kinds of treatments there are for you. If you decide that you don’t want
to be in the study after we begin, that’s OK too. Nobody will be angry or upset. We are discussing
the study with your parents and you should talk to them about it too.

Your responsibilities
It is the responsibility of your parent / guardian to come along with you to the hospital during the
study period for all the visits unless you withdraw or do not continue to receive treatment/care as
per the study. It is also your responsibility and your parent / guardian to report any side effects
that you may experience while on the study.
CHILD ASSENT FORM

I__________________________________________, agree to participate in the study, “The

Educational and Social Implications of Sabong sa Kaka (Spider Derby) Among
Elementary Learners.”

I have been informed, to my satisfaction, by the attending physician, about the study. I know that
my parents/guardians do not have to bear the expenses of the treatment if I suffer from any study
related injury, which may be related to the study drug/ procedure/ device.

I am also aware of my right to not be part of the trial, at any time, without having to give reasons
for doing so

___________________________
Date
Name and Signature of the study participant :

___________________________
Name and Signature of Legally Acceptable Date
Representative :

___________________________
Date
Name and Signature :

Parent Information sheet and Informed Consent Form

Study Title: The Educational and Social Implications of Sabong sa Kaka (Spider Derby) Among
Elementary Learners by Naptali P. Cayuna

Introduction:
Your child is invited to participate in a study/research/experiment. This document gives you a
description of the study/trial in which you are being asked to participate. Your participation in this
study is voluntary, and you can enquire about all details before giving your written consent to
participate in the study.

Purpose:
The purpose of this study is to know the implications of the game to elementary learners.

Participant selection
Your decision to have your child participate in this study is entirely voluntary. It is your choice
whether to have your child participate or not. If you choose not to consent, all the services you
and your child receive at this clinic will continue and nothing will change. You may also choose to
change your mind later and stop participating, even if you agreed earlier, and the services you
and/or your child receives at the clinic will continue

Duration
The research takes will not take more than 20 minutes of his/her time.
Side Effects
There are no known side effects in conducting this study.

Risks
There are no known risks in conducting this study.

Discomforts
There are no known discomforts in conducting this study.

Benefits
There may not be any other benefit for your child but his/her participation is likely to help us find
the answer to the research question. There may not be any benefit to the society at this stage of
the research, but future generations are likely to benefit.

Confidentiality
The information that we collect from this research project will be kept confidential. Information
about your child that will be collected from the research will be put away and no one but the
researchers will be able to see it. Any information about your child will have a number on it instead
of his/her name. Only the researchers will know what his/her number is and we will lock that
information up with a lock and key. It will not be shared with or given to anyone.

Sharing the Results

The knowledge that we get from this study will be shared with you before it is made widely
available to the public. Confidential information will not be shared. There will be small meetings
in the community and these will be announced. Afterwards, we will publish the results in order
that other interested people may learn from our research

Right to Refuse or Withdraw

You do not have to agree to your child taking part in this research if you do not wish to do so and
refusing to allow your child to participate will not affect your treatment or your child's treatment at
this Centre in any way. You and your child will still have all the benefits that you would otherwise
have at this Centre. You may stop your child from participating in the research at any time that
you wish without either you or your child losing any of your rights as a patient here.

Consent
The nature and the purpose of the above Research Study have been explained to my child and
me; we have agreed to have my child participate in the research study. We also agree that my
child’s personal health information can be collected, used and shared by the researchers and staff
for the research study described in this form. We will receive a signed copy of this consent form.

___________________________
Date
Signature of Parent/Guardian :

___________________________
Date
Signature of Subject (when appropriate) :

___________________________
Signature of person obtaining Date
consent/authorization :

___________________________
 Date
Signature of impartial witness :