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Online Zoom Consent Form/Text

To participate in these zoom events you must agree to the Zoom consent form below.

 

Alternative Cook, LLC
Consent Form for Participation in Discussion Group

Subject: Discussion on book titled Gluten-Centric Culture – The Commensality Conundrum

Facilitator: Dr. Jean Elizabeth Duane

Discussion Site: Virtual Discussion Application (such as Zoom)

Purpose
You will be participating in a virtual (Zoom or a similar type application) discussion.  The purpose of this discussion is for participants to share scenarios and to understand more about the relational aspects of adults who have gluten sensitivities.

Procedures
As a discussion group participant, you may be invited to ask and answer questions, may volunteer to contribute stories and opinions, and may contribute help other participants develop strategies to navigate social conundrums. You understand that the discussion will be recorded and may be used in research conducted by Dr. Jean Duane. If used, your name will be replaced with a pseudonym.

Participation
Participating in this discussion is completely voluntary. Even if you decide to participate now, you may change your mind and stop at any time. You may choose not to continue with the discussion by closing the session, for any reason without penalty or other benefits to which you are entitled.

Risks or Discomforts
Potential risks and/or discomforts of participation may include minor emotional distress while contemplating the struggles associated with living with dietary restrictions.

Benefits
Possible benefits of participation include providing insight for adults who live the gluten free lifestyle by supplying information on how others cope. Further, the on-going research conducted by Dr. Duane will afford caregivers, cooks, and others a path to empathy by creating an awareness of the plight of everyday life for those with severe food sensitivities.

Consideration to Participate
You will be charged a discussion participation fee. This fee is non-refundable.

Confidentiality
Audio and video recordings of the discussion groups will be preserved. Audio portions (protecting visual identities of discussion participants) may be used in a variety of ways including, but not limited to, quotations of participants used in research studies and audios used in an audio-montage. Identity of individuals participating in this study will not be disclosed when information is presented or published. However, should any information contained in the discussions be the subject of a court order or lawful subpoena, Alternative Cook, LLC might not be able to avoid compliance with the order or subpoena. The research information may be shared with federal agencies or local committees who are responsible for protecting research participants, including individuals on behalf of celiac.com.

Participant Eligibility
Before you begin, please note that the data you provide may be collected and used by Alternative Cook, LLC.  This research is only for US residents over the age of 18 (or 19 in Nebraska).  Please be mindful to use a secured Internet connection for your privacy.  Your confidentiality will be maintained to the degree permitted by the technology used.  Specifically, no guarantees can be made regarding the interception of data sent via the Internet by any third parties. 

Questions
If you have any questions about this project or your participation, please feel free to ask questions now or contact Dr. Jean Duane here

 

Digiital Signature
By checking the box below you are consenting to this agreement and you digitially signing this document

 

required to continue
I have read and understand the Consent Form for Participation the Discussion Group for the Gluten-Centric Culture – The Commensality Conundrum book and agree to be audio and video recorded.