INFORMED CONSENT FORM
Title of the Study:
AKTIBO: A Proposed Advanced Sports Science Research and Rehabilitation Complex in Cavite
Researcher(s):
Name of Researcher: Ainnah Mae B. Cuevas
Affiliation: College of Architecture, University of Perpetual Help System DALTA – Molino
Campus
Contact Information: 09262320960/ [Link]@[Link]
Co-Investigator(s) or Adviser:
Name: Ar. Felipe R. Balasbas Jr.
Role/Title: Thesis Adviser
Contact Information: ___________________________
1. PURPOSE OF THE STUDY
You are being invited to participate in a research study being conducted by Ainnah Mae B.
Cuevas from University of Perpetual Help System DALTA – Molino Campus. This study
aims to:
This study aims to provide a sports science research and rehabilitation complex that will
adapt advanced technologies for the enhancement and optimization of athletes’
performance and recovery in sports injuries.
The findings of this study may contribute to improved practices, theoretical insights, or policy-
making in the fields of sports science.
2. PARTICIPANT INVITATION AND ELIGIBILITY
You have been selected to participate in this study because:
You are worker or officer-in-charge in the department.
You meet the eligibility requirements defined by the research protocol.
Participation is completely voluntary and you may decline without any consequences.
3. PROCEDURES INVOLVED
If you agree to participate in this study, you will be asked to take part in:
A one-on-one interview
Estimated duration: 30 minutes – 1 hour
Number of sessions (if applicable): __
Mode: face-to-face
Location: Philippine Sports Commission
The session may be audio- and/or video-recorded with your consent. You may choose to
decline recording.
You may be asked to:
Answer questions about sports injuries, research and rehabilitation facilities for
sports science.
Share opinions, reflections, or personal experiences relevant to the study.
4. VOLUNTARY NATURE OF PARTICIPATION
Your participation is entirely voluntary. You may:
Decline to answer specific questions
Pause or discontinue participation at any time
Withdraw from the study before, during, or after participation—without penalty or loss of
benefits
5. POTENTIAL RISKS OR DISCOMFORTS
This study may involve the following minimal risks:
Fatigue from long discussions or surveys
Privacy concerns
Risk Mitigation Measures:
You may stop the session at any time or skip questions
Group discussions will include confidentiality agreements
6. POTENTIAL BENEFITS
While there is no direct or monetary benefit to you, you may gain:
Personal insight or reflection on your own leadership and identity
Opportunity to contribute to academic knowledge and social development
Access to a summary of research findings upon request
7. CONFIDENTIALITY AND DATA PROTECTION
Your personal information and data will be handled with strict confidentiality. The following
measures will be applied:
Data will be anonymized using codes or pseudonyms
Personal identifiers will be removed from transcripts or reports
Digital files will be stored in encrypted, password-protected folders
Only the researcher(s) and adviser will have access to raw data
Data will be retained for __ years and securely destroyed after
If interviews or sessions are recorded:
Audio/video recordings will be deleted after transcription and verification
No images, names, or voice recordings will be published without your explicit written
permission
8. COMPENSATION OR INCENTIVES
No compensation or incentive will be provided for participation.
9. USE OF STUDY FINDINGS
The data collected may be used for:
Undergraduate/graduate thesis or dissertation
Academic publications or conferences
Institutional reports or policy briefs
Your identity will not be disclosed in any of these outputs unless you provide explicit written
permission.
10. PARTICIPANT RIGHTS
By signing this form, you acknowledge that:
You have the right to ask questions at any stage of the research
You may refuse to answer any question
You may withdraw from the study at any time
You may request access to your data, or request it be removed (before final analysis)
11. ETHICS APPROVAL AND COMPLAINTS
This research has been reviewed and approved by the Research and Development Center of
UPHSD – Molino.
If you have concerns or complaints regarding this study, you may contact:
[Link]@[Link]
STATEMENT OF CONSENT
Please check the appropriate boxes:
☐ I have read and understood the information provided above.
☐ I was given the opportunity to ask questions, and they were answered clearly.
☐ I understand that participation is voluntary and I can withdraw at any time.
☐ I voluntarily agree to participate in this research study.
☐ I consent to audio and/or video recording. (Optional)
Participant’s Name (Print): _______________________________________
Participant’s Signature: _________________________________________
Date: ___________________________
FOR PARTICIPANTS UNDER 18 YEARS OLD
Parent/Guardian Consent:
☐ I have read the study information and give permission for my child to participate.
☐ I understand their participation is voluntary and confidential.
Parent/Guardian Name (Print): ____________________________________
Signature: _________________________________________
Date: ___________________________
FOR RESEARCHER’S USE
I confirm that I have explained the nature and purpose of the study, procedures, potential risks,
and participant rights in clear language, and that the participant has voluntarily agreed to
participate.
Name of Researcher (Print): AINNAH MAE B. CUEVAS
Signature: _________________________________________
Date: ___________________________