Consent form

Informed Consent form

Project: Self-injury; an artistic-historical investigation

Principal Investigator: Dr. Alanna Skuse, Department of English Literature

Additional Investigator: Associate Professor Tina O’Connell, Department of Art

Contact: a.d.skuse@reading.ac.uk

Please mark your initials in the box after each statement to confirm it has been read and agreed to.

  1. I have read and had explained to me by Dr. Alanna Skuse or Professor Tina O’Connell the accompanying Information Sheet relating to the project on Self-Injury, History, and Me. ☐
  2. I have had explained to me the purposes of the project and what will be required of me, and any questions I have had have been answered to my satisfaction. I agree to the arrangements described in the Information Sheet in so far as they relate to my participation. ☐
  3. I have had explained to me what information will be collected about me, what it will be used for, who it may be shared with, how it will be kept safe, and my rights in relation to my data. ☐
  4. I understand that participation is entirely voluntary and that I have the right to withdraw from the project any time, and that this will be without detriment. ☐
  5.  I understand that the data collected from me in this study will be preserved and made available in anonymised form, so that they can be consulted and re-used by others. ☐
  1. I agree to grant the University of Reading a worldwide, non-exclusive license to distribute the artworks from this study on terms of its choosing. ☐
  2. This project has been reviewed by the University Research Ethics Committee, and has been given a favourable ethical opinion for conduct. ☐
  3. I have received a copy of this Consent Form and of the accompanying Information Sheet. ☐

Name: ………………………………………………………………………………

Date of birth: ………………………………………………………………………

Signed: ………………………………………………………………………………

Date: …………………………………………………………………………………

I am happy to be included on a register of research participants for the purposes of being contacted about further studies by the University of Reading.  Please mark with your initials    ☐ (optional)