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Parent Consent for an Online Survey

Young People's Access to Professional Mental Health Support

Highbury Roundhouse is proud to launch our mental health survey in partnership with the Young Londoners Research Programme, commissioned by the Greater London Authority.

Highbury Roundhouse is supporting three young people from our youth club, Nassiirah Kureembocus, Anisa Lleshi and Zainab Popal. They will investigate the barriers that young people are facing in accessing professional mental health services in Islington.

We are asking that your child/young person take part in a research study. The survey will take about 7 minutes to complete.

If you choose to allow your child/young person to be in the study, he/she will complete a survey. The survey will contain questions about their experiences with mental health and access to professional mental services.


To participate in this online study, your child/young person need to be:

  • Aged 13-15 years old

  • And live in Islington

Your child/young person can skip questions that he/she does not want to answer or stop the survey at any time.

The survey is anonymous.

If your child/young person participate in the study, he/she will be allowed to enter a price draw of £150. 

The information you will share with us if you participate in this study will be kept completely confidential to the full extent of the law. 

Your information will be assigned a code number that is unique to this study. If you opt to give any personal details, such as your name or email address, this will be kept in a locked database called Upshot, and only the researchers and their supervisors can see the survey you participated in. 

When the study is completed, and the data has been analysed, the list linking participants' personal information (if any given) to study numbers will be destroyed.

Study findings will be presented only in summary form, and your personal details will not be used in any report (if any given). While the investigators will keep your information confidential, there are some risks of data breaches when sending information over the internet that are beyond the control of the investigators. 


Parental Consent:


Typing your name and the date below represents your signature affirming that you agree that the above information has been explained to you and all your current questions have been answered.  You understand that you may ask questions about any aspect of this research study during the course of the study and in the future.  By signing this form, you agree that your child/young person may participate in this research study.


Parent or legal responsible full name:






Child/young person's name:


Typing his/her name and the date below represents your child/young person's signature affirming that this research has been explained to him or her and that he/she agrees to participate.

Minor's name:






If you have any questions about this study, please get in touch with Eneida Capaldi at

If you have questions about your rights as a research participant, don't hesitate to contact Iris Bos, Youth Research Officer at Partnership for Young London,

PDF file for printing here.

*Please print the file, complete and return it to Save a copy of this form for your records*.

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