Consent form

Electronic Signature

Please read the statements and activities below and check all those that apply.

I carefully read and considered the information about the Early Check follow-up study activities. I understand that by taking part in these activities my daughter is continuing her participation in Early Check. * I give permission for my daughter to participate in the assessments of her and her family’s well-being at the two Early Check follow-up study visits. I give my permission for my daughter to enroll in the Early Check Research Registry. Please enter your child's full name * Today's date * Enter your full name * Today's date * By checking this box, I attest that this information is accurate * Please accept this as my signature * I understand that I may be invited to join future studies.

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This research study is funded by The National Institutes of Health (NIH) and the John Merck Family Fund. This means that the research institutions are receiving funds from NIH and the John Merck Family Fund to conduct this research.

The Early Check follow-up study has been approved by the University of North Carolina at Chapel Hill Institutional Review Board (IRB). An IRB is a committee that reviews research to protect the rights and welfare of participants. If you have questions about your rights as a research participant, you may contact the IRB at 919-966-3113 or by email to IRB_subjects@unc.edu.

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