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Informed Consent Form 1
Informed Consent Form 1
2. There are no anticipated risks associated with your participation in the study.
3. While there are no expected benefits associated with your participation in the study, you may
gain new understanding of your experiences.
4. Although the results of this study may be published, no information that could identify you will
be included. You will be referred to only by a code name.
6. Refusal or discontinued participation in the study will not result in any penalty or loss of benefits
or rights to which you might otherwise be entitled.
7. Your consent is given voluntarily. You are free to refuse or withdraw your participation at any
point anytime in the study without affecting your relationship with the researchers of this study.
You also have the right not to answer questions you do not wish to answer.
8. Should you have questions about this research, please address them to the researchers listed
above or to Mrs. Catherine C. Valera, the Inquiries, Investigations and Immersion teacher, at
09179869801 or at catherine_calixto@yahoo.com or to the Senior High School Principal, Mr.
Louie Sonny D. Rivera at rogationistcollege.shs@gmail.com.
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Researcher’s Signature Date
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Researcher’s Signature Date
________________________________________ _____________________
Researcher’s Signature Date
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Researcher’s Signature Date
Your signature above indicates that you voluntarily agree to participate in this study and that
you have read and understood the information provided above. Meanwhile, the signature of
the researcher on this document indicates agreement to include the named participant in the
research. This also indicates that the researchers explained the nature and purpose of this
study and the participants have been fully informed of their rights. Also, any question the
participant has about this study has been answered and any future questions will be
answered as they arise.
Please also indicate below if you wish to receive a summary of the findings of this research
which will be available around March 2018. YES_✓_ NO_____
Address: Blk. 14. Lot 01, Austria St. Barcelona 1, Buhay na Tubig, Imus, Cavite