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Ghoulic

consent to participate

Ghoulic
Jan 26th, 2024 (edited)
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  1. [div align="center"][div style="width:80%;padding:1px;border:6px solid #3D3D3D;background-color:#333333;"][div style="padding:1px;border:1px dashed #3d3d3d;"][div style="border:3px double #3d3d3d;padding:20px;"][img alt=" " style="max-width:100px;opacity:0.8px;" src="https://cdn.discordapp.com/attachments/737752580687527967/980862069198950451/wizengamot_grey_badge.png"][div style="font-family:times new roman;font-size:15px;"]Consent to Participate[/div]
  2. [div style="border-bottom:1px solid #3d3d3d;height:1px;width:75%;"][/div]
  3. [div style="font-family:times new roman;font-size:13px;line-height:14px;opacity:0.9;"][table style="width:100%;"][tbody][tr][td style="border:1px solid transparent;border-right:1px solid #606060;border-bottom:1px solid #606060;padding:10px;width:80%;"]1. I confirm that I have read the information sheet for this study. I have had the opportunity to consider the information, ask questions, and have these answered satisfactorily.[/td][td style="border:1px solid transparent;border-bottom:1px solid #606060;padding:10px;width:20%;"][div align="center"][img style="max-width:100%;" src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp"][/div][/td][/tr][tr][td style="border:1px solid transparent;border-right:1px solid #606060;border-bottom:1px solid #606060;padding:10px;width:80%;"]2. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected. [/td][td style="border:1px solid transparent;border-bottom:1px solid #606060;padding:10px;width:20%;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp" style="max-width:100%;"][/div][/td][/tr][tr][td style="border:1px solid transparent;border-right:1px solid #606060;border-bottom:1px solid #606060;padding:10px;width:80%;"]3. I understand that relevant sections of my medical notes and data collected during the study may be looked at by individuals from [ company ], where it is relevant to my taking part in this research. I give permission for these individuals to have access to my records. [/td][td style="border:1px solid transparent;border-bottom:1px solid #606060;padding:10px;width:20%;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp" style="max-width:100%;"][/div][/td][/tr][tr][td style="border:1px solid transparent;border-right:1px solid #606060;border-bottom:1px solid #606060;padding:10px;width:80%;"]4. I agree to donate samples of [ insert ]. I consider these samples a gift to [ company ], and I understand I will not gain any direct personal or financial benefit from them. [/td][td style="border:1px solid transparent;border-bottom:1px solid #606060;padding:10px;width:20%;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp" style="max-width:100%;"][/div][/td][/tr][tr][td style="border:1px solid transparent;border-right:1px solid #606060;border-bottom:1px solid #606060;padding:10px;width:80%;"]5. I understand that withdrawing my consent does not nullify any other legal documents I may have signed in accordance with this study, including but not limited to Release of Liability waivers or Non-Disclosure Agreements[/td][td style="border:1px solid transparent;border-bottom:1px solid #606060;padding:10px;width:20%;"][div align="center"][img style="max-width:100%;" src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp"][/div][/td][/tr][tr][td style="border:1px solid transparent;border-right:1px solid #606060;padding:10px;width:80%;"]6. I agree to take part in this study.
  4.  
  5. [/td][td style="border:1px solid transparent;padding:10px;width:20%;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjI4LjYwNjA2MC5hVzVwZEdsaGJBLjA/the-valensia-demo.regular.webp" style="max-width:100%;"][/div][/td][/tr][/tbody][/table][div style="height:10px;"][/div][table][tbody][tr][td style="padding:10px;border:1px solid transparent;width:50%;font-size:11px;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjQwLjYwNjA2MC5jMmxuYm1GMGRYSmxJR1Y0WVcxd2JHVS4w/the-valensia-demo.regular.webp" style="height:35px;opacity:0.9;padding-bottom:5px;border-bottom:1px solid #606060;"]
  6. SIGNATURE OF PARTICIPANT[/div][/td][td style="padding:10px;border:1px solid transparent;width:50%;font-size:11px;"][div align="center"][img src="https://txt.1001fonts.net/img/txt/b3RmLjQwLjYwNjA2MC5jMmxuYm1GMGRYSmxJR1Y0WVcxd2JHVS4w/the-valensia-demo.regular.webp" style="height:35px;opacity:0.9;padding-bottom:5px;border-bottom:1px solid #606060;"]
  7. SIGNATURE OF RESEARCHER[/div][/td][/tr][/tbody][/table][/div][/div][/div][/div][/div]
  8.  
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