PARTICIPANT INFORMED CONSENT FORM FOR LEGAL ACCEPTABLE

REPRESENTATIVE(LAR)

Study Title: Comparison of levels of Oxidative biomarkers between children with Autism
Spectrum Disorder aged 2-18 years and typically developing children: A cross Sectional
Study
Principal Investigator: Dr Chinthana L, Junior Resident, Department of Pediatrics, AIIMS,
New Delhi
Chief Guide: Dr. Sheffali Gulati, Professor and Head, Child Neurology division,
Department of Pediatrics, AIIMS, New Delhi
Your signature/thumb impression on this form indicates that you have read and/or understood to
your satisfaction, the information regarding participation in the research project and agree to be
interviewed. In no way does this waive your legal rights nor release the investigators, sponsors or
involved institutions from their legal and professional responsibilities.

I, Mr/Mrs________________________, Father/Mother/Guardian of ____________________

(child‘s name)have read the contents of the information sheet provided to me/ have been
explained clearly the aims, methods, benefits and risks of participation in this project in a
language that I comprehend, and I have fully understood the contents. I confirm that I have had
the opportunity to ask questions. I understand that my participation in the study is entirely
voluntary and I have also been informed that I can withdraw from the study at any time without
losing on any benefits/treatment for which my child is entitled.

I understand that the information collected about my child from my participation in

thisresearch and sections of any of my medical notes may be looked at by responsible individuals
from AIIMS, New Delhi or from regulatory authorities where it is relevant to my taking part in
research. I give permission for these individuals to have access to my records.
I agree to give consent for my child to take part in the above study

Participant‘s Signature/Thumb impression ______________________________

Investigator‘s Signature: Date:

Witness‘s Signature: Date:

Note: This consent form will be read to participants who are unable to read, in a language they
can understand