General Consent Form
This General Consent Form is designed to comply with the laws of the state of [State Name]. Please fill in the required information where indicated.
Participant Information:
- Name: ____________________________
- Date of Birth: ______________________
- Email: ____________________________
- Phone Number: ______________________
Consent Statement:
I, the undersigned, hereby give my consent for the following:
- To participate in [describe the activity or program].
- To the collection and use of my personal information as outlined in the privacy policy.
- To receive communication regarding the activity or program.
Risks and Benefits:
I acknowledge that I have been informed of the potential risks and benefits associated with my participation. I understand that I can withdraw my consent at any time without penalty.
Signature:
By signing below, I confirm that I have read and understood this consent form.
Signature: ____________________________
Date: _________________________________
If the participant is under 18 years of age, a parent or guardian must sign below:
Parent/Guardian Name: ____________________________
Signature: _____________________________________
Date: _________________________________________