PARENT PERMISSION FORM So your child is interested in joining MOOSE crossing? Terrific! MOOSE Crossing is a research project of Amy Bruckman and the Georgia Institute of Technology. The goal of MOOSE Crossing is to give kids a meaningful context to learn reading, writing, and computer programming. Access is free, and is open to kids 13 and under. Adults 18 and over must apply to be mentors or "Rangers." Teenagers 14-17 must apply to be Junior Rangers. If you have any questions about registration, see: http://www.cc.gatech.edu/~asb/moose-crossing/ For your child to participate, you must complete both the parent and child application forms, and the parent questionnaire, and connect to the MOOSE Crossing login screen to request a character (if you have not already done so). This parental permission form has two parts: an informed consent form, and a code of conduct. We believe (but can not guarantee) that your child will learn from his/her participation in this project. This project involves use of the Internet, and all Internet usage for children involves possible risks. While we try to provide a safe environment, we can not guarantee that some third party will not use the system to make inappropriate materials available to children, or that dangerous persons will not gain access to the system. To help educate your child about safe Internet use, a code of net safety is provided. Reports of injury or reaction should be made to Amy Bruckman at 404-894-9222. Neither the Georgia Institute of Technology nor the principal investigator has made provision for payment of costs associated with any injury resulting from participation in this study. For research purposes, almost everything that is typed on MOOSE Crossing is recorded. Participants are also occasionally asked to answer interview questions by phone, email, or in person. This data will be kept confidential, and will be used only for research purposes. Descriptions of your child and records of his or her experiences may appear in written and oral presentations of the results of this research, with his or her name changed to ensure confidentiality. Your child has rights as a research volunteer. Taking part in this study is completely voluntary. If your child does not take part, there will be no penalty. Either you or your child may discontinue your child's participation at any time with no penalty. If you have any questions about your rights as a research volunteer, call or write: IRB Administrator Office of Research Compliance Georgia Institute of Technology Atlanta, GA 30332-0420 Phone: (404) 894-6949 Your signature below indicates that the researchers have answered all of your questions to your satisfaction and that you consent to your child's participation in this study. _____________________________________________ Parent or Legal Guardian--Print Your Name Here _____________________________________________ ____________________ Parent or Legal Guardian--Sign Your Name Here Date CODE OF CONDUCT A code of conduct is included on the child application form. This includes guidelines for behavior expected of participants. If your child breaks the rules, his/her account may be either temporarily or permanently discontinued. Membership in MOOSE Crossing is a privilege, not a right. The code of conduct also includes guidelines for your child's safety. One authority on the subject of child safety online writes: "Most people who use online services have mainly positive experiences. But, like any endeavor--traveling, cooking, or attending school--there are some risks. The online world, like the rest of society, is made up of a wide array of people. Most are decent and respectful, but some may be rude, obnoxious, insulting, or even mean and exploitative." We recommend that you ask your child: * Not to give out your home address or phone number to anyone he/she meets online, and * Not to agree to meet anyone face to face. If your child wants to meet another child face to face, we recommend that you set up a meeting in a public place, and make sure each child is accompanied by a parent. CODE OF CONDUCT--PARENTAL AGREEMENT I have spoken with my child about the code of conduct, and he/she understands it and has promised to abide by it. I have spoken with my child about the importance of not giving out our home address or phone number, or meeting with people face to face. My child understands why this is important and will abide by it. _____________________________________________ Parent or Legal Guardian--Print Your Name Here _____________________________________________ ____________________ Parent or Legal Guardian--Sign Your Name Here Date _____________________________________________ _________________ Witness--Sign Your Name Here Date To activate your child's account, we need to make sure we can match up parent forms, child forms, and online applications. Has your child already requested a MOOSE Crossing character online? If so, what character name did he/she request? _____________________________________________ Print Character Name Requested _____________________________________________ Email Address (parent's, child's, or both) _____________________________________________ Print CHILD's name here ************************************************************************* Please print out this form, the kid form, and the parent questionnaire. Complete them, sign them, and return them via surface mail to: MOOSE Crossing Applications c/o Amy Bruckman College of Computing 801 Atlantic Ave Georgia Institute of Technology Atlanta, GA 30332-0280 USA You can also fax them to 404-894-3146. Sorry, but we can not accept applications via email. More information is available at: http://www.cc.gatech.edu/~asb/moose-crossing/ If you have any questions or problems, send email to: moose-request@cc.gatech.edu We're sorry there's so much to do before your child can try MOOSE Crossing out, but these forms are part of how we try to make MOOSE a safe place for kids. Thank you for your patience with these formalities! -- Amy Bruckman *************************************************************************