Republic of the Philippines

DEPARTMENT OF EDUCATION
Division of Angeles City
ANGELES CITY SCIENCE HIGH SCHOOL
Doña Aurora Street, Lourdes Sur East, Angeles City

INFORMED CONSENT FORM

(For Research Participants, Informants and Respondents)

Response of the Ethnic Group of Mt. Pinatubo to Resurgence of Technology

Instruction: Kindly read and sign this Informed Consent Form. This will be the document that specifies
your voluntary participation in a research which shall be conducted in the vicinity of Tarlac City.

THIS IS TO CERTIFY THAT I AM VOLUNTARILY PARTICIPATING IN THE STUDY WHERE I AM

ASKED TO ACT AS A RESEARCH PARTICIPANT OR INFORMANT OR RESPONDENT.

1. I AM JOINING IN MY OWN VOLITION.I WAS NOT FORCED AGAINST MY WILL AND THAT I
AM DOING THIS TO CONTRIBUTE TO THE ADVANCEMENT OF RESEARCH.

2. I AM NOT RECEIVING ANY MONETARY RENUMERATION /INCENTIVE THROUGH ANY

FAVORS FOR ME TO PARTICIPATE.

3. I KNOW THAT I CAN WITHDRAW FROM PARTICIPATION ANYTIME THAT I WANT TO.

4. I PROMISE AND AGREE TO ANSWER HONESTLY AND TRUTHFULLY ANY QUESTION

ASKED OF ME BY THE RESEARCHER WHICH MAY COME IN THE FORM OF INTERVIEWS,
OBSERVATIONS OR QUESTIONNAIRES.

5. I PROMISE AND AGREE TO COOPERATE FULLY WITH THE RESEARCHER REGARDING

ANY FOLLOW-UP DATA GATHERING PROCEDURES WHICH THEY MAY CONDUCT AFTER
SIGNING THIS INFORMED CONSENT FORM.

6. THE RESEARCHER HAVE EXPLAINED WELL THE PURPOSE OF HIS OR HER RESEARCH TO
ME AND THAT NO PHYSICAL OR PSYCHOLOGICAL HARM IN ANY WAY WILL BE USED TO
ANYONE INVOLVED IN RESEARCH

___________________________ ______________________

Signature over printed Name Date Signed