Consent form Survey ‘2010-now Giving up a Child for Adoption in the Netherlands’

We have asked you to take part in the 2010-now National Adoption Survey. By agreeing to the information in this form, you give your permission to participate in the survey.

Are you well prepared?

Have you read the participants’ information about the survey?
Were you able to ask questions, if any, to the surveyors?
Have you taken enough time to decide on participating in the survey?

It is important that you know this

Your participation to the survey is voluntary. It is your choice whether you want to take part or not.
You may decide not to take part after all.
You are allowed to stop the survey at any given moment.
Your answers in the questionnaire remain anonymous. Nobody knows who completed the questionnaire. Even the surveyors don’t know.

Tick the boxes relevant to your situation

During your pregnancy, you considered giving your child up for adoption.

You received counselling from an organization.

This took place in 2010 or later.

Your child was born at least three months ago.

You are aged 16 or over.

* If you do not meet all requirements, unfortunately you're not able to take part in the survey. Thank you for your time.

Permission for taking part in the survey

I declare to take part in the survey.

I agree to the terms and conditions drawn up by Fiom.

I declare that I am completing this questionnaire truthfully and only once

Consent form Survey ‘2010-now Giving up a Child for Adoption in the Netherlands’