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Consent Form<br />

ACSIS: A Paediatric Haematology/Oncology study of the quality of life and<br />

wellbeing of childhood cancer survivors on New Zealand.<br />

I have read and understood the participant information sheet that<br />

was sent to me.<br />

I know I can ring the contact people listed on the participant<br />

information sheet at any time I want more information.<br />

I understand that taking part in the survey is entirely my choice.<br />

I understand that the questionnaire is confidential and anonymous.<br />

I understand that I will not be able to be identified from any reports<br />

arising from this research.<br />

I Accept I Don’t Accept<br />

This study has been approved by the Upper South B Regional Ethics<br />

Committee.<br />

Reference number: URB/09/05/017<br />

90

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