Client Research Participation Release Form

The Undersigned (“Undersigned” means only the Participant when the Participant is age 18 or older or it means both the Participant and the Participant’s parent(s) or legal guardian(s) when the Participant is under the age of 18) hereby grants permission to use all test results and scores obtained from evaluation, both formal and informal, of below named client while said client was/is in attendance of programs associated with Joy Meadows, Inc. and/or Pediatric Connections OT Services, PA to be used for research studies and/or published research materials. It is understood that no use of the client’s name will be included in any published material. No promises have been made to me to secure my signature to this release other than the intention of Joy Meadows Inc. and/or Pediatric Connections OT Services, PA or other associated programs or consultants to use the test results and scores obtained from evaluations for the purpose of educational work and research.