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Consent Form (for the MIT community) for the Affective Tigger project

Researchers from Massachusetts Institute of Technology, in the group of Affective Computing, are conducting a study to evaluate a prototype toy that was designed to respond to how your child interacts with it. Your and your child's participation in the following experiment are completely voluntary. Either of you are free to withdraw this consent at any time, for any reason, and to request that any data collected be destroyed. If at any time either of you feel uncomfortable, or unsure that you wish your results to be part of the experiment, you may discontinue your participation with no repercussions.

By participating in this study, you will receive $10 in monetary compensation for your and your child's participation. The results of this study may result in a better understanding of new methods for interaction between computers and children. Participation in this study presents minimal risk to your child. Your child may become confused during their participation as they play with a toy that is unfamiliar to them, and which may respond to your child in unexpected ways. However, the level of this confusion should not exceed anything that they would have during an everyday encounter with a new toy. This is a two part time commitment of your and your child's time. The session should last less than an hour. In one week there will be a follow up phone interview of approximately five minutes in length. In a few minutes, you will begin participating in an experiment that will include the following:

A) Answering a few preliminary questions.

B) Introduction to a new kind of toy.

C) Performing a series of playful tasks with this new toy.

D) Sharing your opinion of the toy.

These tasks are designed to expose the Affective Tigger's reaction to different emotional situations. They are expected to elicit responses and feelings within your child. Any and all responses are normal. If at any time either of you are uncomfortable, either physically, or with what you or your child are being asked to do, or how the Affective Tigger is responding, you are free to ask that the experiment be suspended.

Any responses that are collected during this experiment will be completely anonymous. From this point forward, your data will be referred to by the ID number that appears on the upper right corner of this paper.

If you have any questions, at any point during the experiment, the experimenter will gladly answer them.

Please read the following and sign on the lines below:

I the undersigned, have read and understood the explanations of the following research project and voluntarily consent to my and my child's participation in it. I understand that all responses will remain confidential and that I may terminate participation at any time. In the unlikely event of physical injury resulting from participation in this research, I understand that medical treatment will be available from the MIT Medical Department, including first aid treatment and follow-up care as needed, and that my insurance carrier may be billed for the cost of such treatment. However, no compensation can be provided for medical care apart from the foregoing. I further understand that making such medical treatment available; or providing it, does not imply that such injury is the investigator's fault. I also understand that by my participation in this study I am not waiving any of my legal rights.

I understand that if I experience any ill effects (either mentally or physically) post-experimentation, I will contact the experiment coordinator: Dana Kirsch (617)253-0384 or (617)666-8378.

I understand that I may also contact the Chairman of the Committee on the Use of Humans of Experimental Subjects, MIT (617)253-6787, if I feel I or my child has been treated unfairly as a subject.

next up previous contents
Next: Consent Form (for the Up: The Release Forms for Previous: The Release Forms for

Dana L Kirsch
Tue May 25 08:59:22 EDT 1999