Parental Consent for a Child to Act as a Subject in a Research Study
Investigation of the Impact of Ballet Dancers Wearing the OrzaPro Soft Ballet Shoe as Compared to the Traditional Soft Ballet Shoe
PRIMARY INVESTIGATOR
Dr. Karin Steere, DPT, PhD
Associate Professor
University of Puget Sound
School of Physical Therapy
1500 N. Warner St. CMB 1030
Tacoma, WA 98416
(253) 879-3528
DESCRIPTION: The purpose of this survey is to explore the dancing experience in different types of soft ballet shoes. This survey will also ask about ballet shoes, and about frequency and types of injuries while wearing ballet shoes. You have been asked about this study because your child is a ballet dancer. If you choose to allow participation for your child, your child will complete an online survey administered through Qualtrics. He/she/they will receive a link via email to the survey and the link will take your child to a separate website where the survey can be completed anonymously. Your child’s participation in this study is completely optional and voluntary.
RISKS AND BENEFITS: This study involves minimal risk to participants. All studies that collect information present the risk of the loss of confidentiality. Participants can skip questions that they do not want to answer or stop the survey at any time. The survey is anonymous, and no one will be able to link your child’s answers back to them or to you. There are no anticipated short- or long-term risks from this study. The choice of what shoe to wear is solely your child’s and survey questions can be answered no matter which type of ballet shoe they decide to wear. This study will provide information on injury types and injury rates of dancers while wearing different types of ballet shoes. The information gained from this study will be used to guide injury prevention for dancers, and the development of strategies to improve dancer physical health and longevity.
NEW INFORMATION: New information gained during the time the research is in progress and relevant information can be provided to you upon request at the completion of the study. COST AND COMPENSATION: There are no costs for participating in this study, and the total time commitment is approximately 5 minutes each time the survey is completed. It is anticipated that your child will receive the survey via email approximately every 3 months for 1 year.
DISCLOSURES: This study is being conducted independently by the University of Puget Sound and is not being influenced by OrzaBrand or any of its affiliates. Neither the primary investigator, Dr. Karin Steere, nor any individual at the University of Puget Sound is receiving compensation from OrzaBrand.
By signing this study consent, you are authorizing your child’s participation in this study, and authorizing the research team to use and share your child’s study-related information until the end of the research study. The study records will be confidentially shredded or electronically deleted for your security when storage is no longer required.
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CONFIDENTIALITY: No names or personally identifying information of participants are being collected. All identifying materials such as these parental consent forms will be collected by the PI to be stored in a password-protected study folder, or locked file cabinet in the office of the PI at the University of Puget Sound.
I understand that information obtained from this survey research will be
kept strictly confidential, and that
there will be no personally identifying information requested in the questionnaire. I understand that my child’s identity will not be revealed in any description or publication of this research.
Therefore, I consent to such publication for scientific purposes.
RIGHT TO REFUSE OR END PARTICIPATION: I understand that my child is free to refuse to participate in this study or to end their participation at any time. My child can refuse to answer any question on the survey.
VOLUNTARY CONSENT: I certify that I have read the preceding or it has been read to me and that I understand its contents. Any questions I have pertaining to the research have been or will be answered by Primary Investigator Dr. Karin Steere (ksteere@pugetsound.edu, 253-879-3528) or the Office of the Associate Provosts (253-879-3207). A copy of this consent form can be given to me or I may request a copy at any time by contacting Dr. Karin Steere.
By signing below, I confirm that I have read the document above and that I freely agree to allow my child to participate in this study.