I voluntarily agree to participate in the evaluation of the differences between my personal birth experiences; namely a medicated childbirth and a natural childbirth. I understand that this evaluation is being conducted by Krystal Schiess, to improve the awareness of women highlighting the differences between these two childbirth methods. I understand that she will use the information I send her to write a book in which I may or may not be compensated for.
I agree to the following:
1. to be totally accurate as I describe the factual events of my deliveries.
2. to allow any information I send to be used in her book as a factual document.
3. to give any related information which Krystal Schiess may require to accomplish her book.
I grant permission for my information to be transcribed only as it appears, and to be used only by Krystal Schiess for this purpose. I grant permission for the data generated to be published in a book for future publication(s).
I understand that any identifiable information in regard to my name and/or my children name’s may be listed only in the author’s reference information and this information will not be listed in the book or any future publication(s).
Lastly, I understand that Krystal will not publish my words without a finalized agreement from myself approving of its publication.
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Research Participant
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Date
