PJ R.

Ragot

12- STEM AQUAMARINE

Parental Consent for Respondents

Date: ___________________

I, the undersigned First name___________ Last name_______ , am the parent or legal

guardian of Name of the Respondent__ , hereby give my consent for his/her participation. As a parent, I
affirm that I have been completely informed that my child has been asked to participate in a research
study about in conducting data collection for research entitled, “Internet Dependency and Addiction
among Teenagers”. I understand the terms and regulations as well as the benefits and/ or compensation
that I may receive.

__________________________________

Signature of Parent/Guardian

___________________________________

Signature of Respondent