First Steps to a Healthy Climate - Consent Form part 1

Consent Form (part 1)
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Research Project Title: First Steps for a Healthy Climate: Exploring grassroots/parent-led community resiliency, civic empowerment and location-based education for climate change
Ethics Application Number: #30000887 
 
Who is conducting this study?
Researcher/Educator: Laurel Hart, Faculty of Education, Simon Fraser University
604-441-0147, laurel_hart@sfu.ca (or) laurelhart@gmail.com
Co-Investigator: Lynn Fels, Simon Fraser University, lynn_fels@sfu.ca
 
Who is funding this study? Funding for this program comes from the City of Vancouver’s Greenest City Grant, a Mitacs accelerate grant, registration fees, and in-kind support (partnership & permission) from the West Side Family Place and Five Family Place Partnership.
 
Invitation & study purpose: Why are we doing this study?
You are invited to participate in the First Steps to a Healthy Climate program (First Steps), as a parent or caregiver with a child age 5 or younger. We want to understand the needs of families and to develop resources to assist families in adapting to a changing world and climate, through the development of the First Steps program.

Study Procedures – What happens to you in the study? How is data collected?
If you take part in this research program and family/educational program, first, you will register through the Family Place and sign the consent form (either during registration or at the start of our first session.) Family Places will gather your basic information for registration in the program and to share with the researcher/educator.
 
You and your child will be invited to attend one session per week, for 6 weeks. Each session is anticipated to last approximately 90 minutes. There may be an optional evening Zoom  gathering, for parents to discuss climate change without children present. Depending on group interest, there may also be an opportunity to take part in an optional special project (like mural making, gardening, or another local activity).
 
The first day, we will collectively decide upon topics to explore over the following weeks. During our weekly sessions, parents will discuss issues while children engage in connected activities.
 
[Recordings] The teacher/researcher will audio record this session and take notes, in order to review it afterwards. Audio recordings will be destroyed once transcribed (typed up).
[Social Media] Resources will be developed throughout the program from the topics we explore, and will be shared regularly through social media sites (e.g., those of Family Places, First Steps to a Healthy Climate), and websites.
[Video and photographs] Activities will be photographed and video documented (as parental consent allows), in order to create resources and share about the program. A separate photo release will be provided at the first session. You do not have to agree to your or your child’s image being shared in order to participate in the program. See information sheet.
Following completion of the First Steps program, the teacher/researcher will keep data collected as part of the study on her password-protected personal computer for up to 7 years.
In-Person Activities / Covid-19.
Full vaccination is required for all participating adults; we will abide by the latest provincial health guidelines in relation to the COVID19 pandemic. You may need to wear a mask.
(If you prefer an online-only program, contact Laurel.)

Is there any way being in this study could be bad for you? (Risks)
We do not think there is anything in this study that could harm you. Climate change can be stressful, but it is a part of our lives. We aim to create a hopeful and helpful space. Should you require extra support, Family Place staff are trained support workers who can meet with you. 

What are the benefits of participating? (Benefits)
You may find it beneficial to be part of a community of caregivers exploring tools, skills, and information for adapting to a changing world. This program seeks to empower, support, and generate resources around climate-friendly behaviours for families. Educators, other parents, and our earth will also likely benefit from the knowledge/resources this program will create.
 
Payment / Fees.
The program fee is $30 per family, payable to the Family Place. Fees can be waved if they prohibit your participation in the program. Financial compensation will not be provided for commercialization activities the researcher undertakes with the data (like publishing a book).
 
Confidentiality – How will your identity be protected and your privacy maintained?
Full confidentiality cannot be maintained in a group setting. While we encourage participants not to discuss personal details shared with people outside the group, we cannot control what participants do. Any data you provide may be transmitted and stored in countries outside of Canada, as well as in Canada. Please note that privacy laws vary in different countries and may not be the same as in Canada.
 
What if I decide to withdraw my consent to participate? What if I want to change my privacy?
At any point, you may withdraw yourself and your child from this study, without giving reasons, and with no effects on any other services you may be entitled to receive. You can withdrawal up to 10 days after the last session*, by contacting Laurel Hart. You can also request a change to how you are identified (by a pseudonym, your real name, or “a parent”). (*See information sheet.)
 
Study results.
Resources developed will be available on the program website: www.firststepsclimate.com and on our social media platforms. Findings will be published in academic journals and presented in conferences. An annual newsletter will be sent to you and research partners via email. You will not be identified in any research outputs unless you have expressly consented to this. The researcher/educator may commercialize findings in the future, for example, by publishing a book or resource guide for parents/educators.

Please see the information sheet (https://tinyurl.com/FirstStepsInfoSheet) for additional details about the research, consent, publication, data retention & security, limitations to withdrawal of data and other details.  
 
Who can you contact for information about the study?
Laurel Hart, 604-441-0147, laurelh@sfu.ca (or) laurelhart@gmail.com.
Who can you contact if you have complaints or concerns about the study?
If you have any concerns about your rights as a research participant and/or your experiences while participating in this study, please contact the SFU Office of Resea
Identification of caregiver and child(ren)
Due to the small group size, and the local nature of the program, it is impossible to ensure anonymity. Even if a pseudonym is used, you may still be identifiable.

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* 1. Parent / caregiver, please select whether you would like to be identified (in research records and publications) by your:

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* 2. If you selected your real name or a pseudonym, please write how you would like to be referred to.
(Note: If you selected pseudonym, you may leave this blank and a pseudonym will be selected for you.)

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* 3. Child(ren). Please select whether you want your child(ren) to be identified (in research records and publications) by their:

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* 4. If you selected your child(ren)’s real name(s) or pseudonym, please write how you would like your child to be referred to (e.g. first name? a nickname?)  
(Note: If you selected pseudonym, you may leave this blank, and a pseudonym will be selected for your child.)

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* 5. Future contact.
Do you grant the teacher/researcher permission to contact you after the study, for follow-up purposes (such as a reunion) or to participate in other studies? 
(Note: You are under no obligation to participate in the future if you select yes.)

PARTICIPANT CONSENT AND SIGNATURE PAGE
Taking part in this study is entirely up to you. You have the right to refuse to participate in this study. If you decide to take part with your child, you may choose to pull out of the study at any time without giving a reason and without any negative impact on your access to further services from Family Places, day care, or engagement with other community groups and organizations.
  • Your signature below indicates that you have received a copy of this consent form for your own records.
  • Your signature indicates that you consent to participate in this study,
  • Your signature indicates (if applicable) that you consent to your child participating in this study.
  • You do not waive any of your legal rights by participating in this study.

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* 6. Upload Signature

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 7. Date (yyyy/mm/dd)

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* 8. Printed Name of the Participant (& Parent or Guardian) signing above

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* 9. Email address

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* 10. Do you have any other questions or comments?

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