ࡱ> sxrz{ Tbjbj 4Lff &5  8tT^&"d#$:#w^y^y^y^y^y^y^$bd^N#T"T"^N#N#^v^^)^)^)N#w^^)N#w^^)^)SiX`ba#U(c^^0^Vhre$rePiX^X8reXdN#N#^)N#N#N#N#N#^^d%N#N#N#^N#N#N#N#reN#N#N#N#N#N#N#N#N#X T:  APPENDIX [INSERT REFERENCE] INFORMED CONSENT FORM FOR LEGAL REPRESENTATIVE in relation to [Insert title of the Research Project as stated on page 1 of the information notice] I have read the information notice and I have been informed by .. orally and in writing (see pages 2 and following) about the nature and the potential consequences and risks of the above-mentioned research project (the Research Project), and I have had sufficient opportunity to ask any questions. I understand that the data of my child or other family member will be collected and used in connection with this Research Project and to enable publication of the research results. I have been informed that I am entitled to withdraw consent on behalf of my child or other family member regarding participation in the Research Project at any time without giving a reason and without negative consequences to him/her. Furthermore, I may object to further processing of his/her personal data and/or samples or request that these be deleted. I may do so by contacting XXXX. Please tick the appropriate boxes in the table below [ADAPT THE QUESTIONS ACCORDING TO YOUR SPECIFIC RESEARCH PROJECT]: IF CONSENT IS CHOSEN AS THE LEGAL BASIS FOR PROCESSING: I consent to the collection and use of personal data of my child or other family member in relation to the Research ProjectYesNoI agree to the data provided by my child or other family member being archived at [INSERT LOCATION] and being used in [pseudonymised] [anonymised] form for other research in the area of [INSERT RESEARCH AREA] beyond the Research ProjectYesNoI consent to interviews with my child or family member being recorded in audio format for the purposes of the Research Project YesOnly if his/her identity is not disclosedNoI consent to interviews with my child or family member being recorded in video format for the purposes of the Research ProjectYesOnly if his/her identity is not disclosedNoI consent to personal data belonging to my child or family member, as described in the information notice, being processed for the purposes of [SPECIFY RESEARCH OUTPUTS], including publication in academic journals YesOnly if his/her identity is not disclosedNoI give consent to be contacted after this Research Project to ask whether my child or family member would be interested in taking part in a follow-up studyYesNoIF APPLICABLE: I consent to the (pseudonymised) data of my child or family member being transferred to [ADD COUNTRY]. I am aware that the laws of [ADD COUNTRY] may not offer the same level of privacy protection as in the European Union.YesNo LEGAL REPRESENTATIVE I have been asked to give consent for [INSERT DETAILS: my child or other family member]: Last name: ______________________ First name:________________________ In my capacity as: ________________________________ Place & date: _______________________________________ Signature of the legal representative:_______________________________________ RESEARCHER I have informed the above-mentioned participant orally and in writing (see pages 1 and following) about the nature and the potential consequences and risks of the Research Project, and I have given the participant the opportunity to ask any questions. In addition, the participant has received a copy of the information sheet(s) and of this consent form. 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