Vaccines for Children - Consent Form

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Vaccines for Children Research Consent Form- SCD

About the Project

 

The Ministry of Citizens’ Services, Ministry of Health, and Government Communications and Public Engagement are working to understand how parents and guardians with children 0-4 and/or 5-11 are finding, accessing and using information and services in the context of COVID-19. 

 

We are taking a human-centred design approach to this work. This includes: 

  • Researching how other provinces are addressing the public’s challenges to finding, accessing, and using information
  • Researching the most recent developments  
  • Talking to people about their experience (user experience) 
  • Creating an online model, or prototype 
  • Testing and improving the model 
 

Audio Recordings and Transcripts

 

To help analyze the results of the research, during the interview or workshop the interviewers may take: 

  • Notes 
  • Audio or video recordings 
  • Photographs 

Your name and any other personal identification are not associated with the recordings. The recordings may be used for training or evaluation purposes.   

 

The recordings are not used for any purpose other than those described in this form, or otherwise permitted by law.  

All recordings, transcripts and notes are stored during the project and then securely disposed of as transitory records in accordance with the Information Management Act and related policies.   

 

Confidentiality

Your confidentiality will be respected.  We will de-identify all notes. Please do not name yourself or others in audio or video recordings.  You can choose not to be recorded.   

 

When individuals’ stories and experiences are recorded, confidential personal information may be shared during the interview or workshop. In compliance with the Freedom of Information and Protection of Privacy Act, all personal information will be protected using appropriate security controls.  

 

 

Notification of Collection 

This information is collected by the Ministry of Citizens’ Services - GDX under section 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act. This information will be used for the purpose of assisting analysis in the project described above. It may be used for training or evaluation purposes.  

 

Should you have any questions about the collection of this personal information, please contact:  

 

Sarah Smythe

A/ Director, Service and Content Design

Government Digital Experience Division, Ministry of Citizens’ Services

Sarah.smythe@gov.bc.ca 

250-883-7158

617 Government St., Victoria, BC V8V 1X6

I agree to being audio recorded for the purposes described.
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I agree to being video recorded for the purposes described.
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I agree to screen-capture recording for the purposes described.
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I agree to being photographed for the purposes described.
Please select an option

I understand the following:

  • I have read and understood the Participant Consent form; 
  • I have had the opportunity to ask questions and have had satisfactory responses to my questions; 
  • I have the option to receive a dated and signed copy of this form. 
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Please provide a valid email address
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We'd like to provide you a gift card to thank you for taking the time to participate in this research.
 

If you want, after the session you will receive a $45 electronic gift card by email from a company called Virtual Incentives.

 

You can choose the type of gift card you want. You can get the gift card even if you don’t complete the session. 

Collection Notification
 
For the purpose of delivering and confirming that you have received your e-Gift card, your personal information is collected through Virtual Incentives under section 26(c) and section 26 (e) of the Freedom of Information and Protection of Privacy Act. Please be aware that your IP address, email address and e-Gift details will be collected by Virtual Incentives. This information will be stored and may be accessed outside of Canada.  
 
If you do not consent to register your e-Gift card through Virtual Incentives, the project team can offer you a physical card. 
 
By selecting "yes" you are consenting to your personal information (IP address, email address and e-Gift details) being stored and/or potentially accessed outside Canada. Your consent is effective as soon as you submit.  
 
If you have any questions about the collection, use or disclosure of your personal information, please contact:  
 

Sarah Smythe

Acting Director, Service and Content Design

Government Digital Experience Division, Ministry of Citizens’ Services

Sarah.smythe@gov.bc.ca 

250-883-7158

617 Government St., Victoria, BC V8V 1X6

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