The Link between Age and the Frequency of Interactions with Children with Autism Spectrum

Disorder, and Perceptions of these Children Consent Form for Parents/Guardians

Matthew Laxer
Marybeth Ruddy and Katherine Peterson
Freehold High School Medical Sciences Learning Center
(732)-395-3488
MatthewLaxer317@gmail.com

Your child is invited to take part in a research study of the link between age and frequency of
interaction with autistic children, and perceptions of these children.

This study is to determine if there is a link between age and frequency of interaction with
children with autism spectrum disorder, and perceptions of these children.

What your child will be asked to do: Your child will be asked to complete a survey consisting
of questions asking their age, frequency of interaction with autistic children, and they will be
ranking

There are no anticipated risks to your child if he or she participates in this study, beyond those
encountered in everyday life.

Your consent and your childs participation in this study are completely voluntary. Your child can
withdraw from the study at any time without consequences of any kind, and you can withdraw
your consent at any time without consequences of any kind. Participating in this study does not
mean that you are or your child is giving up any legal rights.

The records of this study will be kept private, and individual data will only be accessible by the
researcher. Any report of this research that is made available to the public will not include your
childs name or any other individual information by which your child could be identified.

If you have questions or want a copy or summary of the study results, contact the researcher at
the email address or phone number above. If you have any questions about whether your child
has been treated in an illegal or unethical way, contact _______________

Statement of Consent: I have read the above information, and have received answers to any
questions. I consent to allow my child to take part in the research study of [topic of research]

___________________________ _________________________ ___________________

Parents/Guardians Signature Childs Name (Please Print) Date

Matthew Laxer
Freehold High School Medical Sciences Learning Center
MatthewLaxer317@gmail.com

The Link between Age and the Frequency of Interactions with Children with Autism Spectrum
Disorder, and Perceptions of these Children
Online Consent Form
You are invited to take part in a research survey about of the link between age and frequency of
interaction with autistic children, and perceptions of these children. Your participation will
require approximately 5 to 10 minutes and is completed online at your computer. There are no
known risks or discomforts associated with this survey. Taking part in this study is completely
voluntary. If you choose to be in the study you can withdraw at any time without consequences
of any kind. Participating in this study does not mean that you are giving up any legal rights.
Your responses will be kept strictly confidential, and digital data will be stored in secure
computer files. Any report of this research that is made available to the public will not include
your name or any other individual information by which you could be identified. If you have
questions or want a copy or summary of this studys results, you can contact the researcher at the
email address above. If you have any questions about whether you have been treated in an illegal
or unethical way, contact ________________________. Please feel free to print a copy of this
consent page to keep for your records.

Clicking the Next button below indicates that you are 18 years of age or older, and indicates
your consent to participate in this survey.

The Link between Age and the Frequency of Interactions with Children with Autism Spectrum
Disorder, and Perceptions of these Children Consent Form

Matthew Laxer
Marybeth Ruddy and Katherine Peterson
Freehold High School Medical Sciences Learning Center
(732)-395-3488
MatthewLaxer317@gmail.com

You are invited to take part in a research study of the link between age and frequency of interaction with
autistic children, and perceptions of these children.

What the study is about: This study is to determine if there is a link between age and frequency of
interaction with children with autism spectrum disorder, and perceptions of these children.

What you will be asked to do: [Briefly describe what participants will do, including all activities or
tasks. NOTE: Include the approximate amount of time it will take for participants to complete the
task(s).]

Risks and benefits: There are no anticipated risks to you if you participate in this study, beyond those
encountered in everyday life.

Taking part is voluntary: Taking part in this study is completely voluntary. If you choose to be in the
study you can withdraw at any time without consequences of any kind. Participating in this study does not
mean that you are giving up any of your legal rights.

Your answers will be confidential: The records of this study will be kept private. Any report of this
research that is made available to the public will not include your name or any other individual
information by which you could be identified.

If you have questions or want a copy or summary of the study results: Contact the researcher at the
email address or phone number above. You will be given a copy of this form to keep for your records. If
you have any questions about whether you have been treated in an illegal or unethical way, contact
________________.

Statement of Consent: I have read the above information, and have received answers to any questions. I
affirm that I am 18 years of age or older. I consent to take part in the research study of the link between
age and frequency of interaction with autistic children, and perceptions of these children.

________________________________ ________________
Participants Signature Date