Biological Basis of Maze Performance Volunteer Informed Consent Form
Name of Project: Biological Basis of Maze Performance
Name of Principal Investigator: Lisa Gabel, Ph.D
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Email *
Description of the study
Recent work has demonstrated that the expression of two genes, identified as DCDC2 and KIAA0319, are associated with performance on our virtual maze task. If your child agrees to participate in this study, we will send a small plastic tube to collect a saliva sample, along with a self-addressed stamped envelope, to the address you provide below.  The researcher will demonstrate how the process works and explain it to your child.  Once the tube is received it will be marked with a unique code so there will be no way to identify an individual sample by your child’s name.  Only the expression of the two genes of interest will be examined to determine if they are associated with performance on the computer task.  Children enrolled in either kindergarten or second grade are eligible to participate in this study. If your child is in second grade, and they previously participated while enrolled in kindergarten, they are still eligible to participate in this study.  Your child is being asked to take part in this research study as a volunteer. Your child, the participant, may choose not to participate in this portion of the study without being penalized in any way. This study is experimental and there are no direct benefits to participants. This study is expected to involve no more than minimal risk associated with spitting in a tube.  Your child may not able to produce saliva when they wish to, which could cause some frustration. Information gathered in this study will be kept confidential and used only for research purposes. The results of this study may be published. Your name and other answers that might identify you will not appear in any article or discussion of the study results. The saliva sample will not be used or distributed for future research studies, even if identifying information is removed.

Other than your time, there is no cost to you for being in this study. If you have any questions at any time about your child’s participation or the study itself, please contact Lisa Gabel at 610-330- 5296 or via email ( If you have questions about your rights as a research participant, e-mail the Chair of the Lafayette IRB at  

Statement of Rights
You have rights as a research volunteer. Your being in this study is completely voluntary. You do not have to be in this study. You may stop taking part in this study for any reason at any time and with no penalty. If you wish, you may have a copy of this form to keep.  You do not waive any of your legal rights by signing this form.
Child's name *
Name of Child's School *
Child's grade/homeroom *
Electronic Signature
Providing an electronic signature below means that you have read this form and consent to my child taking part in this research project.
Electronic signature (parent or guardian) *
Today's date *
Contact information
We will reach out to you via email or text message (your preference) to schedule a day and time that will work best for you and your child.  Please provide an email address and/or a cell phone number below.
Email Address
Cell phone number (optional)
If you have any additional question about the project please feel free to write your questions below and we will respond as soon as possible.
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