14-09-2023

STANDARD EC-FORMS

1.a Information brochure

1.b Informed consent form

2.a Information brochure for parents/guardians for research involving children

2.b Informed consent form for parents/guardians for research involving children

3.a Information brochure for parents/guardians for research via school/institution

3.b Informed consent form for parents/guardians for research via school/institution

INSTRUCTION: - REPLACE, REMOVE OR MAKE BLACK ALL BLUE TEXT PARTS

- FOR [NAME DEPARTMENT / CAPACITY GROUP / RESEARCH SCHOOL] CHOOSE ONE OPTION
- DELETE GREEN PARTS IF NOT APPLICABLE, MAKE THEM BLACK IF APPLICABLE
- ADJUST DESCRIPTIONS TO YOUR OWN PROJECT
- ADJUST LEVEL OF INFORMATION AND LANGUAGE TO YOUR RESEARCH PARTICIPANTS
 [1.a]
Information brochure for
[TITLE RESEARCH PROJECT]

Dear participant,

You will be taking part in the [TITLE RESEARCH PROJECT] research project conducted by [NAME
EXECUTING RESEARCHER – STUDENT / PHD STUDENT] under supervision of [NAME RESPONSIBLE
RESEARCHER – LECTURER / (CO-) PROMOTOR] at the University of Amsterdam [NAME DEPARTMENT /
CAPACITY GROUP / RESEARCH SCHOOL]. Before the research project can begin, it is important that
you read about the procedures we will be applying. Make sure to read this brochure carefully.

Purpose of the research project

[DESCRIPTION OF THE RESEARCH PROJECT; THIS NEEDS TO BE UNDERSTOOD BY NON-EXPERTS, SO NO
JARGON!]
E.g.: As we know from prior research, babies learn a great deal about their mother tongue
during their first year. They do this by listening to the language being spoken around them,
before they are actually able to understand what is being said.
Over the course of this research, we will be attempting to find out how effectively
adults can learn a language by simply listening to it. We will then compare our findings with
the learning behaviour displayed by babies under the same circumstances. This will help us
find out how people learn a language by simply listening to it. It will also help us determine
how our ability to learn a language changes over the course of our lives. This research is
important because it offers insight into one of the most important skills babies and young
child learn: understanding and speaking their mother tongue. It will also help us understand
why adults often find it more difficult to learn a new language.
[IF IT IS NECESSARY TO MISLEAD PARTICIPANTS TO SOME EXTENT IN ORDER TO PREVENT THAT THE
INFORMATION INFLUENCES THE OUTCOME OF THE RESEARCH, THE FOLLOWING TEXT COULD BE USED:] At this
stage of the project, we cannot provide any further information on the factors we will be
examining. You will receive further details after the experiment has ended.

Who can take part in this research?

[DESCRIPTION OF THE PARTICIPANTS GROUP]
E.g.: We are inviting adult speakers of the Dutch language to take part in this research.
Before the experiment begins, we will be asking you some questions about your hearing and
eyesight. In view of the nature of the research, it is important that you have good hearing and
eyesight. You may wear glasses or contact lenses. We will also be asking a number of
questions about your language background. You can take part in this research project if
Dutch is your mother tongue and you were not brought up in a bilingual household. We also
need to make sure that you do not, to the best of your knowledge, have any language
problems such as dyslexia or a specific language disorder.

Instructions and procedure

[DESCRIPTION OF THE PROCEDURE, SO THAT PARTICIPANTS KNOW WHAT IS GOING TO HAPPEN AND HOW
LONG IT WILL TAKE]
E.g.: During the first part of the experiment, you will be alone in a research laboratory. The
researcher will be in the room next door. She will be able to see you through a window and
hear you via a microphone. You will then hear a number of sounds over the loudspeakers, at
a volume of approximately 70 dB. You will then be requested to answer questions about
these sounds on a computer. This task will take approximately ten minutes.
In the second part of the experiment, you will be seated in front of a Tobii eye-tracking
screen. A bar in the bottom section of the screen contains an infrared lamp that will shine on
your face. This allows the infrared camera in the screen to track your eye movements and the
size of your pupils. The infrared light in harmless and invisible to the naked eye. The data
from the eye tracker will be stored and analysed at a later stage of the research project. A
separate video camera will also record your face and the sounds in the room. The researchers
will only use this material if the eye-tracking signal is not clear enough.
First, the system will calibrate the machine to your eyes. You will see a moving ball on
screen, which you must follow with your eyes. This will take several minutes. You will then
hear sounds similar to those played during the first part of the experiment. In the meantime,
you will see circles on screen. Every ten seconds, a moving ball will appear. You may blink
as you normally would, and move your eyes around the screen. This will take five minutes.
The final part of the experiment is identical to the first, and will last 10 minutes.
The total duration of the experiment will be [XXX].

Voluntary participation
You will be participating in this research project on a voluntary basis. This means you are
free to stop taking part at any stage. This will not have any consequences and you will not be
obliged to finish the procedures described above. You can always decide to withdraw your
consent later on. If you decide to stop or withdraw your consent prior to publication of the
research results, all the information gathered up until then will be permanently deleted.
However, if information has been anonymised, it cannot be deleted because it is not possible
to trace back the information to individual participants.

Discomfort, Risks & Insurance

E.g.: The risks of participating in this research are no greater than in everyday situations at
home. Previous experience in similar research has shown that no or hardly any discomfort is
to be expected for participants.
For all research at the University of Amsterdam, a standard liability insurance applies.

Confidential treatment of your personal details

The information gathered over the course of this research will be used for the purpose of this
research project. Your personal details will not be used in publications, and we guarantee that
you will remain unidentifiable in all publications, unless you explicitly provide consent to
share your personal information. [IN CASE OF RECORDINGS] Eye-tracking / video / audio
recordings will also never be shown in public without your explicit consent. You can provide
such consent on the informed consent form if you wish to do so.
The data gathered during the research will be [e.g. encrypted and stored separately from
the personal details. These personal details and the encryption key are only accessible to
members of the research staff.]
Anonymised data will be stored for a period of [XXX – STANDARD PERIOD IN THE HUMANITIES
IS 10 YEARS]. The non-anonymised data will only be stored as long as is necessary for the
research and will be deleted as soon as possible, unless you explicitly provide consent to store
it for a longer period. You can provide such consent on the informed consent form if you
wish to do so.
Data subject rights according to the GDPR
Participants can request more information from the researcher at any time about their rights
as data subjects under the EU privacy law, the GDPR.

Reimbursement
[A REIMBURSEMENT OR SMALL GIFT CAN BE GIVEN IF SO DESIRED]
E.g.: You will receive a 10 Euro reimbursement for taking part in the research project. If you
wish, we can send you a summary of the general research results at a later stage.

Further information
For further information on the research project, please contact [NAME RESPONSIBLE RESEARCHER, IF
SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER . FOR THESIS RESEARCH, ALWAYS MENTION THE
SUPERVISOR] (phone number: +31 20 – 525 [XXX]; email: [XXX]@uva.nl; Spuistraat 134,
1012VB Amsterdam, The Netherlands).
If you have any complaints regarding this research project, you can contact the
secretary of the Ethics Committee of the Faculty of Humanities of the University of
Amsterdam, [email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam,
The Netherlands.
 [1.b]
Informed consent form

‘I hereby declare that I have been clearly informed about the research project [TITLE RESEARCH
PROJECT] at the University of Amsterdam, [NAME DEPARTMENT / CAPACITY GROUP / RESEARCH
SCHOOL], conducted by [NAME EXECUTING RESEARCHER – STUDENT / PHD STUDENT] under supervision
of [NAME RESPONSIBLE RESEARCHER – LECTURER / (CO-) PROMOTOR] as described in the information
brochure. My questions have been answered to my satisfaction.
I realise that participation in this research is on an entirely voluntary basis. I retain the right to
revoke this consent without having to provide any reasons for my decision. I am aware that I
am entitled to discontinue the research at any time, and that I can always withdraw my
consent after the research has ended. If I decide to stop or withdraw my consent, all the
information gathered up until then will be permanently deleted.
If my research results are used in scientific publications or made public in any other way,
they will be fully anonymised. My personal information may not be viewed by third parties
without my express permission.
If I need any further information on the research, now or in the future, I can contact [NAME
RESPONSIBLE RESEARCHER, IF SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER. FOR THESIS
RESEARCH, ALWAYS MENTION THE SUPERVISOR] (phone number: +31 20 – 525 [XXX]; e-mail:
[XXX]@uva.nl; Spuistraat 134, 1012 VB Amsterdam, The Netherlands.
If I have any complaints regarding this research, I can contact the secretary of the Ethics
Committee of the Faculty of Humanities of the University of Amsterdam; email: commissie-
[email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam, The Netherlands.

I consent to:
[ADD/REMOVE IF NOT APPLICABLE. FOR THE STORAGE PERIOD OF PERSONAL DETAILS PROVIDE AN ESTIMATION
OF THE ACTIVE RESEARCH PHASE, NOT THE PERIOD OF 10 YEARS WHICH ARE VALID FOR ANONYMOUS
RESEARCH DATA. NOTE THAT IN MANY CASES THE OPTION OF SHARING WITH THIRD PARTIES DOES NOT APPLY.]
- participate in this research yes / no
- video/audio recordings being made yes / no
- my personal details to be stored for a period of [XXX] yes / no
- my personal details to be shared with [e.g. third parties] yes / no

Signed in duplicate:

…………………………… ………………………. ……………………………

Name participant Date Signature

‘I have explained the research in further detail. I hereby declare my willingness to answer any
further questions on the research to the best of my ability.’
…………………………… ………………………. ……………………………
Name researcher Date Signature
 [2.a – Information brochure for research with children]
Information brochure for parents for
[TITLE RESEARCH PROJECT]

Dear parent/guardian,

You and your child will be participating in the [TITLE RESEARCH PROJECT] research project
conducted by [NAME EXECUTING RESEARCHER – STUDENT / PHD STUDENT] under supervision of
[NAME RESPONSIBLE RESEARCHER – LECTURER / (CO-) PROMOTOR] at the University of Amsterdam
[NAME DEPARTMENT / CAPACITY GROUP / RESEARCH SCHOOL]. Before the research project can begin,
it is important that you read about the procedures we will be applying. Make sure to read this
brochure carefully.

Purpose of the research project

[DESCRIPTION OF THE RESEARCH PROJECT; THIS NEEDS TO BE UNDERSTOOD BY NON-EXPERTS SO NO JARGON!]
E.g.: As we know from prior research, babies learn a great deal about their mother tongue
during their first year. They do this by listening to the language being spoken around them,
before they are actually able to understand what is being said. Researchers at the University
of Amsterdam are conducting a research project to find out how babies become familiar with
a language’s sound structure by simply listening to the sounds around them.
We will start by playing your baby the sounds of an unfamiliar language. We will then
carry out tests to determine which differences between these sounds your baby can identify.
Obviously, babies cannot tell us what we would like to know through speech, so we will
determine what they know from the way in which they look at pictures while listening to
sounds. This research is important because it helps us to understand how babies discover
patterns in the stream of sounds they hear around them. This will help us gain more insight
into one of the most remarkable skills babies and young children learn: understanding and
speaking their mother tongue.

Who can take part in this research project

[DESCRIPTION OF THE PARTICIPANTS GROUP]
We have invited 6-months old babies to take part in this research. Before the start of the
experiment, we will be asking you a number of questions about your pregnancy, the birth of
your baby, and its development until now. Your baby can take part in the experiment if he or
she was born on time and without complications, and is developing normally. In view of the
nature of the research, it is also important to make sure there are no problems with your
baby’s hearing or eyesight. We will also be asking you a number of questions about the
language you speak at home and both parents’ language background. Your baby can take part
in the experiment if its mother tongue is Dutch and it is generally surrounded by Dutch
speakers. We also need to make sure that neither of the baby’s (biological) parents has any
language problems such as dyslexia or a specific language disorder.

Instructions and procedure

[DESCRIPTION OF THE PROCEDURE SO THAT PARTICIPANTS KNOW WHAT IS GOING TO HAPPEN]
E.g.: During the first part of the experiment, you and your baby will be in the research
laboratory together. The researcher will be in the room next door. She will be able to see you
and your baby through a window and hear you via a microphone. We will then play various
sounds over the loudspeakers, at a volume of approximately 70 dB. You do not have to pay
attention to these sounds. However, we will ask you to speak to your baby as little as possible
while the sounds are being played. This part of the experiment will last about 8 minutes.
For the second part of the experiment, you will place your baby in a car seat in front of
a Tobii eye tracking screen. A bar in the bottom section of the screen contains an infrared
lamp that will shine on your baby’s face. This allows the infrared camera in the screen to
track your baby’s eye movements and the size of its pupils. The infrared light in harmless and
invisible to the naked eye. The data from the eye tracker will be stored and analysed at a later
stage of the research project. A separate video camera will also record your baby’s face and
the sounds in the room. The researchers will only use this material if the eye-tracking signal
is not clear enough.
The researcher will be with you in the research laboratory for a few moments at the
start of the experiment. She will make a moving ball appear in various parts of the eye-
tracking screen. As your baby follows the ball, the system will automatically calibrate the eye
tracker to its eyes. This will take about 5 minutes. The researcher will then leave the research
laboratory, and the test will begin. Your baby will hear sounds similar to those played during
the first part of the experiment. In the meantime, circles will appear on the screen. A moving
ball will appear every ten seconds, to draw your baby’s attention to the screen. You will be
sitting on a chair behind your baby, listening to music on a pair of headphones. We will ask
you to make as little contact with your baby as possible during the experiment, so that we can
observe its spontaneous reactions. This will take about 5 minutes.
The total duration of the experiment will be [XXX].

Voluntary participation
You and your baby will be participating in this research project on a voluntary basis. This
means you are free to stop taking part at any stage. This will not have any consequences and
you will not be obliged to finish the procedures described above. You can always decide to
withdraw your consent later on. If you decide to stop or withdraw your consent, all the
information gathered up until then will be permanently deleted.

Discomfort, risks & insurance

E.g.: The risks of participating in this research are no greater than in everyday situations at
home. Previous experience in similar research has shown that no or hardly any discomfort is
to be expected for participants.
For all research at the University of Amsterdam, a standard liability insurance applies.

Confidential treatment of your personal details

The information gathered over the course of this research will be used for the purpose of this
research project. No personal details will be used in publications, and we guarantee that your
baby will remain unidentifiable in all publications, unless you explicitly provide consent to
share your baby’s personal information. [IN CASE OF RECORDINGS] Eye-tracking / video / audio
recordings will also never be shown in public without your explicit consent. You can provide
such consent on the informed consent form if you wish to do so.
The data gathered during the research will be [e.g. encrypted and stored separately from
the personal details. These personal details and the encryption key are only accessible to
members of the research staff.]
Anonymised data will be stored for a period of [XXX – STANDARD PERIOD IN THE HUMANITIES
IS 10 YEARS]. The non-anonymised data will only be stored as long as is necessary for the
research and will be deleted as soon as possible, unless you explicitly provide consent to store
it for a longer period. You can provide such consent on the informed consent form if you
wish to do so.
Data subject rights according to the GDPR
Participants can request more information from the researcher at any time about their rights
as data subjects under the EU privacy law, the GDPR.

Reimbursement
[A REIMBURSEMENT CAN BE GIVEN IF SO DESIRED; FOR CHILDREN THIS IS USUALLY A SMALL GIFT]
E.g.: As a token of our appreciation for your participation, your baby will receive a small gift.
If you wish, we can send you a summary of the general research results at a later stage.

Further information
For further information on the research project, please contact [NAME RESPONSIBLE RESEARCHER, IF
SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER . FOR THESIS RESEARCH, ALWAYS MENTION THE
SUPERVISOR] (phone number: +31 20 – 525 [XXX]; email: [XXX]@uva.nl; Spuistraat 134,
1012VB Amsterdam, The Netherlands).
If you have any complaints regarding this research project, you can contact the
secretary of the Ethics Committee of the Faculty of Humanities of the University of
Amsterdam, [email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam,
The Netherlands.
 [2.b – Informed consent form for research involving children]
Parental informed consent form

‘I hereby declare that I have been clearly informed about the research project [TITLE RESEARCH
PROJECT] at the University of Amsterdam, [NAME DEPARTMENT / CAPACITY GROUP / RESEARCH
SCHOOL], conducted by [NAME EXECUTING RESEARCHER – STUDENT / PHD STUDENT ] under supervision
of [NAME RESPONSIBLE RESEARCHER – LECTURER / (CO-) PROMOTOR ] as described in the information
brochure. My questions have been answered to my satisfaction.
I hereby declare that I am authorised to sign the consent form for my child’s participation in
this research.
I realise that participation in this research is on an entirely voluntary basis. I retain the right to
revoke this consent without having to provide any reasons for my decision. I am aware that
my child is entitled to discontinue the research at any time and realise that I can always
withdraw my consent and my child’s participation after the research has ended. If my child
decides to stop or I withdraw my consent, all the information gathered up until then will be
permanently deleted.
If the research results of the child under my custody are used in scientific publications or
made public in any other way, they will be fully anonymised. The child’s personal
information may not be viewed by third parties without my express permission.
If I need any further information on the research, now or in the future, I can contact [NAME
RESPONSIBLE RESEARCHER, IF SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER. FOR THESIS
RESEARCH, ALWAYS MENTION THE SUPERVISOR] (phone number: +31 20 – 525 [XXX]; e-mail:
[XXX]@uva.nl; Spuistraat 134, 1012 VB Amsterdam, The Netherlands).

If I have any complaints regarding this research, I can contact the secretary of the Ethics
Committee of the Faculty of Humanities of the University of Amsterdam; email: commissie-
[email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam, The Netherlands.

I consent to:
[ADD/REMOVE IF NOT APPLICABLE. FOR THE STORAGE PERIOD OF PERSONAL DETAILS PROVIDE AN ESTIMATION
OF THE ACTIVE RESEARCH PHASE, NOT THE PERIOD OF 10 YEARS WHICH ARE VALID FOR ANONYMOUS
RESEARCH DATA. NOTE THAT IN MANY CASES THE OPTION OF SHARING WITH THIRD PARTIES DOES NOT APPLY.]
- my child participating in this research yes / no
- video/audio recordings being made yes / no
- my child’s personal details to be stored for a period of [XXX] yes / no
- my child’s personal details to be shared with [e.g. third parties] yes / no

Signed in duplicate:

……………………………
Name of participant (child)

…………………………… ………………………. ……………………………

Name parent/ guardian Date Signature

‘I have explained the research in further detail. I hereby declare my willingness to answer any
further questions on the research to the best of my ability.’

…………………………… ………………………. ……………………………

Name researcher Date Signature
 [3.a – Information brochure for research via school / institution]
Information brochure for parents for
[TITLE RESEARCH PROJECT]

Dear parents/guardians,

Your child’s school is participating in the [TITLE RESEARCH PROJECT] research project conducted
by [NAME EXECUTING RESEARCHER – STUDENT / PHD STUDENT] under supervision of [NAME
RESPONSIBLE RESEARCHER – LECTURER / (CO-) PROMOTOR] at the University of Amsterdam [NAME
DEPARTMENT / CAPACITY GROUP / RESEARCH SCHOOL]. Before the research project can begin, it is
important that you read about the procedures we will be applying. Make sure to read this
brochure carefully.

This type of research cannot be carried out without the participation of children in the [XX–
XX] age group / in group [X]. Most children enjoy taking part in this type of research. The
school board regards participation in this research project as useful, and deems that
participation does not go against the children’s interests or those of the school. The research
will take place at school, and will be scheduled around your child’s lessons.

Your child can participate in the research taking place in the coming weeks / in the week of
[X]. We would like to ask your permission for your child’s participation. Your child’s data
will be treated confidentially and only used in scientific publication after being anonymised.
Participation is completely voluntary and you or your child can decide at any moment to stop
taking part. The research has been approved by the Ethics Committee of the Faculty of
Humanities of the University of Amsterdam.
You can give your consent for your child’s participation in this research by signing the
consent form attached to this information brochure.

Purpose of the research project.

[DESCRIPTION OF THE RESEARCH PROJECT; THIS NEEDS TO BE UNDERSTOOD BY NON-EXPERTS SO NO JARGON!]
E.g.: This research was set up to study how children learn the Dutch grammar rules and the
rules that are important for learning to read and spell.

Instructions and procedure

[DESCRIPTION OF THE PROCEDURE SO THAT PARTICIPANTS KNOW WHAT IS GOING TO HAPPEN]
E.g.: The research consists of a number of playful tasks like listening to sentences, repeating
words and sentences or discovering visual patrons on a computer.
Generally speaking, children enjoy taking part in this type of research. The test is not very
difficult or strenuous. Before the start of the test, your child will be given a detailed
explanation and the opportunity to practice, so that it clearly understands the test and can
carry out the required tasks without any problems. Due to the nature of the research, the test
will be very similar to a game, and is suitable for children.
The test will last approximately [XXX] minutes, including breaks.

Voluntary participation
Your child will be participating in this research project on a voluntary basis. You are free to
decide that you do not want your child to take part in the research. Your child is also free to
decide that it does not want to take part or wants to stop taking part at any stage of the
project. You or your child do not have to give any reason for your decision, and this decision
will not have any negative consequences for your child. You can always decide to withdraw
consent. If your child decides to stop taking part, or if you withdraw your consent, all the
information gathered up until then will be permanently deleted

Discomfort, risks and insurance

E.g.: The risks of participating in this research are no greater than in everyday situations at
home. Previous experience in similar research has shown that no or hardly any discomfort is
to be expected for participants.
For all research at the University of Amsterdam, a standard liability insurance applies.

Confidential treatment of your personal details

The information gathered over the course of this research will be used for the purpose of this
research project. No personal details will be used in publications, and we guarantee that your
baby will remain unidentifiable in all publications, unless you explicitly provide consent to
share your baby’s personal information. [IN CASE OF RECORDINGS] Eye-tracking / video / audio
recordings will also never be shown in public without your explicit consent. You can provide
such consent on the informed consent form if you wish to do so.
The data gathered during the research will be [e.g. encrypted and stored separately from
the personal details. These personal details and the encryption key are only accessible to
members of the research staff.]
Anonymised data will be stored for a period of [XXX – STANDARD PERIOD IN THE HUMANITIES
IS 10 YEARS]. The non-anonymised data will only be stored as long as is necessary for the
research and will be deleted as soon as possible, unless you explicitly provide consent to store
it for a longer period. You can provide such consent on the informed consent form if you
wish to do so.

Data subject rights according to the GDPR

Participants can request more information from the researcher at any time about their rights
as data subjects under the EU privacy law, the GDPR.

Reimbursement
[A REIMBURSEMENT CAN BE GIVEN IF SO DESIRED; FOR CHILDREN THIS IS USUALLY A SMALL GIFT]
E.g.: As a token of our appreciation for your participation your baby will receive a small gift.
If you wish, we can send you a summary of the general research results at a later stage.

Further information
For further information on the research project, please contact [NAME RESPONSIBLE RESEARCHER, IF
SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER . FOR THESIS RESEARCH, ALWAYS MENTION THE
SUPERVISOR] (phone number: +31 20 – 525 [XXX]; email: [XXX]@uva.nl; Spuistraat 134,
1012VB Amsterdam, The Netherlands).
If you have any complaints regarding this research project, you can contact the
secretary of the Ethics Committee of the Faculty of Humanities of the University of
Amsterdam, [email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam,
The Netherlands.
 [3.b – Informed consent form for research via school / institution]
Parental informed consent form

‘I hereby declare that I have been clearly informed about the research project [TITLE RESEARCH
PROJECT] at the University of Amsterdam, [NAME DEPARTMENT / CAPACITY GROUP / RESEARCH
SCHOOL], conducted by [NAME EXECUTING RESEARCHER – STUDENT / PHD STUDENT ] under supervision
of [NAME RESPONSIBLE RESEARCHER – LECTURER / (CO-) PROMOTOR ] as described in the information
brochure. My questions have been answered to my satisfaction.

I hereby declare that I am authorised to sign the consent form for my child’s participation in
the aforementioned research.

I realise that participation in this research is on an entirely voluntary basis. I retain the right to
revoke this consent without having to provide any reasons for my decision. I am aware that
my child is entitled to discontinue the research at any time and realise that I can always
withdraw my consent and my child’s participation after the research has ended. If my child
decides to stop or I withdraw my consent, all the information gathered up until then will be
permanently deleted.

If the research results of the child under my custody are used in scientific publications or
made public in any other way, they will be fully anonymised. The child’s personal
information may not be viewed by third parties without my express permission.

If I need any further information on the research, now or in the future, I can contact [NAME
RESPONSIBLE RESEARCHER, IF SO DESIRED ALSO THE NAME OF THE EXECUTING RESEARCHER. FOR THESIS
RESEARCH, ALWAYS MENTION THE SUPERVISOR] (phone number: +31 20 – 525 [XXX]; e-mail:
[XXX]@uva.nl; Spuistraat 134, 1012 VB Amsterdam, The Netherlands).

If I have any complaints regarding this research, I can contact the secretary of the Ethics
Committee of the Faculty of Humanities of the University of Amsterdam; email: commissie-
[email protected]; Binnengasthuisstraat 9, 1012 ZA Amsterdam, The Netherlands.

I consent to:
[ADD/REMOVE IF NOT APPLICABLE. FOR THE STORAGE PERIOD OF PERSONAL DETAILS PROVIDE AN ESTIMATION
OF THE ACTIVE RESEARCH PHASE, NOT THE PERIOD OF 10 YEARS WHICH ARE VALID FOR ANONYMOUS
RESEARCH DATA. NOTE THAT IN MANY CASES THE OPTION OF SHARING WITH THIRD PARTIES DOES NOT APPLY.]
- my child’s participation in this research yes / no
- video/audio recordings being made yes / no
- my child’s personal details to be stored for a period of [XXX] yes / no
- my child’s personal details to be shared with[e.g. third parties] yes / no

Signed in duplicate:

……………………………
Name of participant (child)
…………………………… ………………………. ……………………………
Name parent/ guardian Date Signature

‘I have explained the research in further detail. I hereby declare my willingness to answer any
further questions on the research to the best of my ability.’

…………………………… ………………………. ……………………………

Name researcher Date Signature