Child Interview Project

Child Interview Consent Form This project has been adapted from the work of Dr. Ann Hussmann.

Important Note: You must obtain parental permission before you conduct the interview. Print out this form and have the parent or guardian sign it. You will need to scan this form or take a picture of it with your cell phone and send it along with your project. If you cannot scan it or take a picture of it, place it in an envelope and bring it to my office on or before the due date. I cannot accept your assignment without this form.

PARENTAL CONSENT FORM I agree to allow the student from El Camino College listed below to interview my child as part of a class project for a Child Growth and Development class. I understand that the questions or activities are age-appropriate and illustrate basic principles of child development. I understand that I have the right to review the questions and activities before the interview begins and that I will receive a summary of the results from the student upon request.

I, _______________________________________________ (print parent’s full name) the parent/guardian of ___________________________________ (child’s name)

age _________ years _________ months

agree to allow

___________________________________________________.

(El Camino Student’s full name here)

_______________________________________________________________ (Parent’s signature)

Date _______________________________________