APPENDIX III

INFORMED CONSENT FOR STUDENTS’ PARENTS/GUARDIANS

CONSENT TO PARTICIPATE IN RESEARCH

(Parental Consent)

Research Title: Mental Health Status Among Senior High School Students of Don Mariano Marcos
Memorial State University-South La Union Campus During Covid-19 Pandemic

Researcher: Dianne D. Villanueva, Jeniffer T. Bautista, Diana Bianca F. Catbagan, Ma. Josabeth F.
Navarro and Malinda Sirue

Introduction:

We the fourth year nursing student namely Dianne D. Villanueva, Jeniffer T. Bautista, Diana
Bianca F. Catbagan, Ma. Josabeth F. Navarro and Malinda Sirue , currently, studying at Don Mariano
Marcos Memorial State University South La Union Campus presently working on our thesis, entitled
“Mental Health Status Among Senior High School Students Of Don Mariano Marcos Memorial State
University-South La Union Campus During Covid-19 Pandemic”.

The school Principal has also given permission for this study to be carried out in your
son/daughter’s school.

With this letter, we would like to ask your permission for your child to take part in the research.

Kindly read this form carefully and ask any questions you may have before deciding whether to allow
your child to participate in the study.

Purpose: The study aims to evaluate the level of depression, anxiety and stress of senior high school
students and will provide baseline information regarding the problems they experienced during this
pandemic.
Procedures:

Risks/Benefits: There are no foreseeable risks involved in participating in this research beyond those
experienced in everyday life. There are no direct benefits to your child from participation in this study,
however the findings may help to increase mental health awareness and may improve quality of life.

Confidentiality: Questionnaires will be made during the course of the research; records of this study will
be kept private. We will not reveal name or any other identification to anyone except for my theses
advice, Mrs. Sheldy M. Peralta RN who is responsible for monitoring our research activities.

Voluntary Participation: Participation in this study is voluntary and will not affect your son/daughter’s
attendance in class or his/her evaluation by the school. If you do not want your child to be in this study,
he/she does not have to participate. Even if you decide to allow your child to participate, he/she is free
not to answer any questions or to withdraw from participation at any time without penalty.

Contacts and Questions:

If you have questions about this research study, please feel free to contact and e-mail us at:
09175253186/ diannedvillanueva@student.dmmmsu.edu.ph

Statement of Consent:

Your signature below indicates that you have read and understood the information provided above,
have had an opportunity to ask questions, and agree to allow your child to participate in this research
study. You will be given a copy of this form to keep for your records.

Please indicate on the attached form whether you permit your son/daughter to take part in this study.
Your cooperation will be very much appreciated.
Sincerely,

______________________________ ________________

Researcher’s Signature Date

Parental/Guardian Consent Form

YES, I agree to allow my child ____________________________________ to participate in:

(Son/daughter’s name)

a. the self reported low back pain questionnaire _______

b. analysis of classroom sitting posture ___________

c. anthropometric data _________

NO, I do not wish my child ____________________________________ to participate in:

(son/daughter’s name)

a. the self reported low back pain questionnaire _______

b. analysis of classroom sitting posture ___________

c. anthropometric data _________