Informed Assent Form for Gen Z Women

This informed assent form is for Gen Z women ages 17 years old and below who are invited to participate
in this research about the perception of Gen Z women towards rhinoplasty in Caloocan City.
This Informed Consent Form has two parts:
• Information Sheet (to share information about the research with you)
• Certificate of Consent (for signatures if you choose to participate)

You will be given a copy of the full Informed Consent Form

Part I: Information Sheet

Introduction
We, the researchers, affiliated with Manila Central University, are inviting you to participate in this
research entitled, “Perception of the Generation Z Women in Caloocan City towards Rhinoplasty.” You
are free to take the time to ask any pertinent questions, concerns, or clarifications you have on this
research. You have the right to decide whether you will participate or not; you are also allowed to
withdraw your participation at any time you want.

Purpose of the research

This research intends to know and understand the perception of gen z women towards rhinoplasty. In
accord with this, we would like to know the thoughts and perceptions you have towards rhinoplasty. We
would like to hear the things you have to say about the said cosmetic procedure.

I have checked with the child, and they understand the purpose of this research. KCD(initial).

Interview
This research will involve your participation in a survey that will take more than or less than 20 minutes.

Participant Selection
You are being invited to take part in this research because as a gen z woman, you can contribute much
to our understanding and knowledge of the perception of gen z women towards rhinoplasty.

Voluntary Participation
Your participation in this survey is entirely voluntary. It is your choice whether to participate or not. If
you choose not to participate, all the services you receive at this institution will continue and nothing
will change. The choices that you will make will have no bearing on your studies or any school-related
evaluations or reports. You may change your mind later and stop participating even if you agreed earlier.

I have checked with the child, and they understand that their participation is voluntary.
HCD(initial).

Procedures
We are asking you to help us learn more about your perception towards rhinoplasty. If you agree to
participate in the research, you will be asked to read and sign this consent form. Afterward, your
child will be asked to complete a questionnaire. The questionnaire will ask about your opinion and
knowledge regarding rhinoplasty. The questions will be age-appropriate and designed to be easily
understood. The collected data will be compiled and used for the result of this study.

I have checked with the child, and they understand the procedures. HCD(initial).

Duration
The survey will take place for about 20 minutes in total. During that time, we will talk about
your experiences.

Page 1 of 3
Risks
There is a risk that you may share some personal or confidential information by chance, or that you may
feel uncomfortable answering the questions. However, we do not wish for this to happen. You do not
have to answer any questions or take part in the discussion if you feel the question(s) are too personal or
if talking about them makes you uncomfortable.

Benefits
There will be no direct benefit to you, but your participation is likely to help us find out more about your
perception towards rhinoplasty.

I have checked with the child, and they understand the risks and benefits.
HCD(initial).

Reimbursements
You will not be given any incentives to take part in the research. However, your time and participation
are very much appreciated.

Confidentiality
We will not be sharing information about you with anyone outside of this research team. The information
that we collect from this survey will be kept private. It will not be shared with or given to anyone.

Sharing the Results

Nothing that you tell us today will be shared with anybody outside the research team and nothing will
be attributed to you by name. If in the future the results will be used for research purposes, rest assured
that confidentiality will be given the utmost priority.

Right to Refuse or Withdraw

You do not have to take part in this research if you do not wish to do so, and choosing to participate will
not affect your studies or school-related evaluations in any way. You may stop participating in the
discussion at any time that you wish without your studies being affected. I will allow you at the end of
the discussion to ask or inform me if you wish to modify or remove portions of our discussion.

Who to Contact
If you have any questions, you can ask them now or later. If you wish to ask questions later, you may
contact the following researchers:
AQUINO, Xandrah Gwyneth – xandrahaquino112205@gmail.com
AVILA, Jona Marie – mariejonaavila@gmail.com
CRUZ, Leanne Colline – cruzleannecolline@gmail.com
GUY, Jhea Alexandrea – guyjhea@gmail.com
SANTOS, Shinah Lorin – shinahlorin@yahoo.com

Part II: Certificate of Assent

I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions I have been asked have been answered to my satisfaction. I
agree to voluntarily participate in this study

Only if the child assents:

Print Name of Participant: Kyla C. Dinglasan
Signature of Participant:
Date: May 7 2023
Day/month/year

Page 2 of 3
If illiterate 1

I have witnessed the accurate reading of the assent form to the child, and the individual has had
the opportunity to ask questions. I confirm that the individual has given consent freely.

Print name of witness: Hazel C. Dinglasan Thumbprint of participant

Signature of witness: _______________
Date: May 7 2023 Day/month/year

I have accurately read or witnessed the accurate reading of the assent form to the potential
participant, and the individual has had the opportunity to ask questions. I confirm that the
individual has given assent freely.

Print name of researcher: _________________

Signature of researcher: ___________________
Date: __________________
Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and to
the best of my ability made sure that the child understands that a survey will be conducted.

I confirm that the child was allowed to ask questions about the research, and all
the questions asked by the participant have been answered correctly and to the best of my
ability. I confirm that the individual has not been coerced into giving consent, and the
consent has been given freely and voluntarily.

A copy of this assent form has been provided to the participant.

Print Name of person taking the consent: Kyla C. Dinglasan

Signature of the person taking the consent:__________________________
Date; May 7 2023
Day/month/year

Copy provided to the participant ________(initialed by researcher)

Parent/Guardian has signed an informed consent /Yes ___No HCD(initialed by

researcher)

1
A literate witness must sign (if possible, this person should be selected by the participant and should have no connection
to the research team). Participants who are illiterate should include their thumbprints as well.

Page 3 of 3