Tattoo consent form

Please enable JavaScript in your browser to complete this form.
Participant's Name
Parent/Guardian Name
Address
How Will My Information Be Used?
The information that you provide about you and your family will be used to [describe the purpose of collecting the information e.g. gain an insight into services and what is important to families].
Consent
I have read the information above and have had an opportunity to ask questions about the [research / activity] and how my information will be used. I understand the purpose of the [research /activity] and what my participation involves. I agree to take part in [describe what involvement the individual will have e.g. an interview] and for the information I provide to be shared with the [area] Partnership agencies and this in turn allows services that I use to share information about me and my family for the purpose of this [research / activity]. I understand that I need to inform the other members of my family that I have given consent which will allow them to opt out if they wish. I understand that anonymized [information / research] about me and my family may be published within the [project report / relevant document], which may be published online and that published material from this [project / report] may be used and distributed for training and service design and development. I know that my participation is voluntary and that I can choose to withdraw from the research at any point.
Clear Signature
Date