CONSENT FORM

The purpose of this form is to provide you (as the parent of a prospective research study participant) information that may
affect your decision as to whether or not to let your child participate in this research study. The person performing the
research will describe the study to you and answer all your questions. Read the information below and ask any questions you
might have before deciding whether or not to give your permission for your child to take part. If you decide to let your child be
involved in this study, this form will be used to record your permission.

________________________________________________________________________________________________________

PARENT SIGNATURE BOX

I, the parent or guardian of _____________________________, a minor ____

years of age permit his or her participation in a program of research conducted by
Ivy Claire butaya, Mike James Alforque, Rocel Saberon, Kyle Vrayam Celestial,
and Jay r Laborte

_________________________ _______________

Signature of parent or guardian date

______________________________

Please print your name here

Student signature box

I, _________________________________, agree to participate in a program of

research and understand that my participation is voluntary.

__________________________ _______________

Signature of the participant date

____________________________________

Please print your name here