Consent form
Thank you for agreeing to take part in an audio recording in relation to MindMate Leeds. This is to help us pass on your views as part of Leeds City Coucil's Adolescent Health Needs Assessment.
MindMate Ambassador discussion on line
Throughout the session we will record the discussion and the audio recording will be passed to Bebhinn Browne, Public Health Specialty Registrar. The information you provide, will help
Audio
Bebhinn (and her team) will be using audio recordings featuring your voice to make notes on what you said. The audio recording will not be shared externally or put online.
Anonoymity
We will keep your personal information anonymous. This means that we will not share you name, date of birth, or contact details with anyone outside of Common Room. We may share details such as age and general location [e.g. Leeds, LS7]
Safeguarding
Common Room takes safeguarding its participants seriously and has a safeguarding policy which all staff work to. As part of this policy, we work to the following confidentiality statement.
Common Room Confidentiality Statement
Common Room offers confidentiality to children, young people and adults we engage with through our work, including staff members. This means we will not normally share information about you to anyone outside the organisation without your agreement. We will keep information about you secure only until it is no longer needed and share this on a need-to-know basis.
There may however be times when we need to share information about you with external partners or organisations when we are concerned that you or someone else are in danger or at risk of significant harm. Wherever possible we will try to discuss this with you and gain your consent before giving out any information. However, if we are unable to do this and feel that telling you would increase the risk, we may choose to do so without your consent.
If you are unsure or would like to know more about the above, please ask one of the workers or email
liz.neill@commonroom.uk.com
Storage of personal data
These recordings will be securely stored by Common Room for a period of up to 6 months when they will be deleted (unless required for safeguarding investigations). You have a right to remove your consent at any time in this period.
What next?
If you have any questions about any of the above please contact liz.neill@commonroom.uk.com.
We need your consent to say that you agree to take part in this activity as outlined above.
Please fill in your details below and tick the boxes below to say you give your consent to take part.
Thank you for submitting your consent to Common Room.
If you are under 16 years old please ensure your parent/guardian completes this [hyperlink to parent form] form also.