Consent form

Working on the phrasing of a informed consent form... Soon I'll be giving trhese out to all the parkour guys. Here's my first take:

Student/Researcher’s Name:
Department:
E-mail:
Phone Number:

Supervisor:
Department:
E-mail:
Phone Number:

Project:
VISUALISING PARKOUR

My name is Alex Pavlotski and I am studying the movement of Parkour in Australia. This is a part of my doctorate studies in anthropology with La Trobe University. By conducting this study I hope to understand the reasons behind the popularity of Parkour in Australia and write a description of the history and philosophy of Parkour generally. Also, I hope to describe the Parkour scene as it currently is, and the transformations that it is currently going through. This is a part of an ongoing effort to understand popular culture, social movements, culture and humanity in general by the discipline of anthropology.

I hope that you may allow me to observe and interview you as a part of this research. You have the right to withdraw from active participation in this project at anytime.

The purpose of gathering this information is to eventually present it as a part of a thesis, but other publications (such as journal articles, book chapters and conference papers) may draw on the information gathered here. Any personal information will be kept completely confidential and all names will be changed or withheld in the products of this study upon your request. All results and any personal information about you I have obtained will be forwarded to you upon your request.

Issue of confidentiality (please check one):
____ I would like for the researcher to use my actual identity. I realise that people who read the completed research project will be able to link my responses to my actual identity.
____ I would like for the researcher to keep my identity confidential. I realise that the information I shared with the interviewer will be used in the research project, but the researcher will use a pseudonym to protect my identity.

I _______________________ have read and understood the information above, and any questions I have asked have been answered to my satisfaction. I agree to participate in the project, realising that I may withdraw at any time. I agree that research data provided by me or with my permission during the project may be included in a thesis, presented at conferences and published in journals on the condition that neither my name nor any other identifying information is used or at full disclosure as I have specified.


Name of Participant (block letters):
Signature: Date

*Name of Authorised Representative (block letters):
Signature: Date

Name of Researcher (block letters):
Signature: Date

**Name of Student Supervisor (block letters): Date: