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Liability Waiver and
Consent Agreement

Read the following agreement and complete the agreement form with initials.

Liability Waiver and Consent Agreement
 

Thank you for your interest in participating in our study on the use of cannabis as a harm reduction and recovery tool. Please carefully review the following terms before agreeing to participate:

  1. Voluntary Participation:
    Participation in this study is entirely voluntary. You may withdraw at any time without penalty or explanation.

  2. Purpose of Study:
    The purpose of this research is to gather self-reported information about the role of cannabis in recovery from substance use and mental health challenges.

  3. Confidentiality:

    • No personally identifiable information (e.g., name, address, contact details) will be linked to your responses in the study data.\n - Your name and contact information will only be used for study-related communication, such as follow-ups or updates on study outcomes.\n - All data will be anonymized and stored securely.

    • Your participation in this self-assessment study is completely voluntary and anonymous. No personal identifiers, including your name, contact information, or any other identifying details, will be collected. All responses will be recorded and analyzed in a way that ensures complete confidentiality.

    • If you are 80 years of age or older, your participation will be treated with the same level of privacy as all other participants. No details that could indirectly identify you, such as specific age, will be included in any reports or publications.

    • We may contact you in the future for a follow-up.

    • We will not sell or give your information to any third party. 

    • By participating, you acknowledge that you understand these privacy protections and agree to proceed under these conditions.

  4. Contact and Follow-Up:

    • You may be contacted for follow-up surveys or interviews, but this will be optional and based on your initial consent.\n - The follow-up will aim to assess longer-term recovery progress and outcomes.

  5. Risk and Liability:

    • There are no known significant risks associated with participating in this study.\n - By agreeing to participate, you release the study organizers from liability for any indirect consequences related to your participation.

  6. Data Use and Publication:

    • The anonymized data collected may be used for academic publications, presentations, or public dissemination through media and social platforms.\n - Individual responses will never be published in a way that could identify you.

  7. Questions and Concerns:

    • For any questions about the study, your participation, or how your data will be used, please contact [Study Coordinator’s Name] at [Email Address/Phone Number].

 

Consent
By signing below, I acknowledge that I have read and understood the terms outlined above. I voluntarily agree to participate in this study and provide my data for the purposes described.

Cannabis as a Tool for Harm Reduction and Recovery Liability Waiver and Consent Agreement

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PEER EDUCATION COMMUNITY CENTER

501(c)3 | EIN: 85-1481975

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