ChIPPA2 Parental Consent Form

Consent Form for sharing a video of a ChIPPA 2 Assessment
As part of the Child-Initiated Pretend Play Assessment 2 (ChIPPA 2) online training, my training involves me sharing videos of myself administering this assessment in a small group of no more than 5 people.

By sharing my video, I am able to practice scoring the assessment.

As part of this training, no one apart from myself has access to the video. I will be sharing the video of the ChIPPA2 assessment from my computer or device in a Zoom session. No other person will have a copy of the video or will be able to access the video.

The video will be shown once only within the training session.
I understand this information and give written consent below*
(parent/carer)
give permission for*
(trainee)
to show a ChIPPA-2 assessment with*
(child's name)
to a small group of other trainees, once, during a training online session.

I understand that no-one else will have access to this video.
Signature*
Date*

DayMonthYear
Your Contact Email
(we will send you a copy of this filled consent form)
When you hit the Submit button below, a PDF copy of this form will be sent directly to Learn To Play Therapy, who are responsible for training ChIPPA assessors.

If you have filled in the Contact Email field above, we will send you confirmation of this submission.
Please verify that you are human*
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Consent Form for sharing a video of a ChIPPA 2 Assessment