Fields v. Palmdale, Part 2
In Part 1, you read that the parents signed a permission slip. This is that permission slip.
Parental Consent
Dear Parent or Caregiver:
The Palmdale School District is asking your support in participating in a district-wide study of our first, third and fifth grade children. The study will be a part of a collaborative effort with The California School of Professional Psychology — CSPP/ Alliant International University, Children’s Bureau of Southern California and the Palmdale School District.
The goal of this assessment is to establish a community baseline measure of children’s exposure to early trauma (for example, violence). We will identify internal behaviors such as anxiety and depression and external behaviors such as aggression and verbal abuse. As a result, we will be designing a district wide intervention program to help children reduce these barriers to learning, which students can participate in. Please read this consent letter and if you agree, please sign and send it back to your school’s principal no later than December 20, 2001.
The assessment will consist of three, twenty-minute self-report measures, which will be given to your child on one day during the last week of January. This study is 100% confidential and at no time will the information gathered be used to identify your child. Your child will not be photographed or videotaped. You may refuse to have your child participate or withdraw from this study at any time without any penalty or loss of services to which your child is entitled.
[—page break—]
I am aware that the research study coordinator, Kristi Seymour, one research assistant, the Palmdale School District, Director of Psychology, Michael Geisser, and a professor from CSPP, will be the only people who have access to the study’s information. After the study is completed, all information will be locked in storage and then destroyed after a period of five years.
I understand answering questions may make my child feel uncomfortable. If this occurs, then, Kristi Seymour, the research study coordinator, will assist us in locating a therapist for further psychological help if necessary. If I have further questions, I may contact Kristi Seymour at 1529 E. Palmdale Blvd., Suite 210, Palmdale, CA 93550 at 661.272.9997 x128. I understand that I will not be able to get my child’s individual results due to anonymity of the children, but I may get a summary report of the study results.
I have read this form and understand what it says. I her[e]by agree to allow my child to participate in this district-wide study.” (emphasis in original).
Additionally, two lines were made available on the “Parental Consent” form for the “Parent/Caregiver” to sign and date it.
Disclaimer: I am not an attorney, nothing I say is legal advice. The text of the permission slip can be found in footnote #1 in
Fields v. Palmdale School Dist.
