WP E-Signature by Approve Me - Sign Documents Using WordPress -

Surf Therapy: The Benefits of Vitamin Sea

INFORMED CONSENT

We invite you to take part in a brief research study entitled “Surf Therapy: The Benefits of Vitamin Sea” taking part from March, 2019 to November, 2019. Taking part in this study is entirely voluntary. We urge you to discuss any questions about this study with staff. If you decide to participate you must sign this form to show that you want to take part.

You are being offered the opportunity to participate in this research study because you or your child has a disability in the area of social, emotional and/or sensory processing domains, is older than 4 years old and is choosing to participate in a full day of surf therapy with A Walk On Water. Approximately 150 people will take part in this research study. The purpose of this study is to obtain information on how surf therapy can positively impact how children with special needs function in their day to day meaningful occupations, including self-care, play, and school activities. It seeks to study the benefits of surf therapy on the social, emotional and sensory processing of children with special needs. The investigators of this study have the intention to publish findings in order to contribute to the growing literature in support of utilizing surf therapy to heal.

Participation in the research study typically takes 7 minutes and is strictly anonymous. Participants of this study will fill out a questionnaire after they have participated in A Walk On Water’s Surf Therapy Event. There will be questions asking about an athlete’s performance in either the Social, Emotional, or Sensory domain, depending on the athlete/caregiver’s identified most significant area of need from the three options. Participants may complete, 1,2 or all three sections. These questions will ask about the athlete’s behaviors PRIOR to the AWOW event, followed by questions about the athlete’s behaviors AFTER the AWOW event.

All responses are treated as confidential, and in no case will responses from individual participants be identified. Rather, all data will be pooled and published in aggregate form only. Participants should be aware, however, that the experiment is not being run from a “secure” https server of the kind typically used to handle credit card transactions, so there is a small possibility that responses could be viewed by unauthorized third parties (e.g., computer hackers).

Signature and Consent/Permission to participate in Research Study: “Surf Therapy: The Benefits of Vitamin Sea”

Before making the decision regarding enrollment in this research you should have:

Discussed this study with an investigator
Reviewed the information in this form
Had the opportunity to ask any questions you may have

Your signature below means that you have received this information, have asked the questions you currently have about the research and those questions have been answered.

Participant’s Legally Authorized Representative: By signing below, you indicate that you give permission for the participant to take part in this research.

Name of Participant:

Name of Participant’s Legally Authorized Representative:
Cell Phone Number:
Relationship between participant and Authorized Representative:
Email:
AWOW Username:

Leave this empty:

Your legal name

A Walk On Water https://awalkonwater.org

Timestamp

Audit

September 1, 2018 4:26 pm PDT

Surf Therapy: The Benefits of Vitamin Sea Uploaded by Cheryl Jones - [email protected] IP 172.119.175.250