Informed Consent: CMK Study Number:
This form provides information regarding the research, so you can choose whether to participate. Please read it carefully.
1. Research Description – The purpose of this research is to gain information that can help improve consumer products that may be marketed by the Researcher, a
consumer goods company. For the purpose of this research, you will be asked to [research description]
2. Voluntary Participation – I understand my participation is completely voluntary and I can withdraw from the research at any time and for any reason. If I choose
not to participate in this research, it will not affect my ability to participate in future studies.
3. Confidentiality/Intellectual property – As the research may involve disclosure and/or development of confidential products, packages, pictures of products,
usage instructions, descriptions of products, and/or ideas and environments, which, separately or together with any (new) brand(s) or brand concept(s), may be
patentable or otherwise protectable by the Researcher, I agree to preserve the confidentiality of this testing and any confidential information in any form, to which
I am exposed during the research, directly or indirectly. I agree that I will neither use nor discuss the above information with anyone, not even with my family
and friends, except the person administering the test. I also agree that my obligations of confidentiality and non-use, extend beyond my participation in the
research. I agree to assign to the Researcher and its affiliates, all ideas, developments, discoveries, works of authorship, designs, software, and/or inventions,
patentable or not, conceived by me as a result of my participation in the research. Furthermore, I agree that the Researcher may use these ideas, developments,
discoveries, works of authorship, designs, software, and/or inventions in any manner it sees fit. My obligations under this agreement will not extend to any
products or other information that are generally known to the public or which become available to the public through no fault of mine.
4. Photo/Video/Audio Release & Use: I understand that certain portions of the research may be audio and/or videotaped or I might be photographed during the
research (make sure this is mentioned in the research description as per paragraph 1). Any recordings in which I appear and other information I provide (e.g. text,
video, images or audio) (“Research Data”) may be used by Researcher for market research, trade presentations, advertising, product innovation, and internal
training as determined by the Researcher, in whole or in part and can be shown to business partners that have an interest in the results of the research.
5. Data Privacy - I understand that if any of my personal information is collected, it will be used for research and for communication with third party business
partners. I also understand Researcher is the controller of such data and will take all reasonable steps to ensure my personal information is protected. I agree that
my personal information can be shared with partner companies and marketing research clients for research purposes. I will not be identified by name in any
publication regarding the Research. If I am a resident of California I have the right to access the personal information Researcher holds about me. I also have the
right to request to delete my personal information. I understand that I can exercise my data protection rights by calling 1-800-331-3774 or contacting the Researcher
at humaninsightsplace.com and referencing my study number as stated above in this Informed Consent. My personal information may be transferred to countries
outside the region in which I live, but my information will still enjoy adequate data protection and safeguards as may be required by the local laws . For more
information, I can visit the Researcher’s privacy policy, available at [humaninsightsplace.com.
6. Limitation of Liability RESEARCHER EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND AS TO ANY PRODUCTS OR EQUIPMENT USED
IN THIS RESEARCH, EXCEPT WHERE PROHIBITED BY LAW. IN NO EVENT WILL RESEARCHER BE LIABLE TO ME FOR ANY DIRECT,
INDIRECT, SPECIAL, PUNITIVE, INCIDENTAL, EXEMPLARY OR CONSEQUENTIAL, DAMAGES, OR ANY DAMAGES WHATSOEVER, WHETHER
IN AN ACTION UNDER CONTRACT, NEGLIGENCE, OR ANY OTHER THEORY, ARISING OUT OF OR IN CONNECTION WITH THE RESEARCH.
I am at least eighteen (18) years of age, or at least nineteen (19) if residing in Alabama or Nebraska, or at least twenty-one (21) if residing in Mississippi. I have read the
above, and I have had the opportunity to ask questions about this research and those have been answered to my satisfaction. I voluntarily agree to be a participant and I
consent to Researcher, its affiliates and/or business partners, processing my personal information in accordance with this document. I acknowledge and explicitly
agree that the personal data processed for the purpose of performing the research (studies) may include processing personal data concerning my health and/or my
racial and ethnic origin. I have received a copy of this consent and understand I can withdraw from the research at any time.
Printed name: _______________________________________________________________________
Signed name: ___________________________________________ Date: _______________________
Person Obtaining Consent Signature: _______________________________ Date: ________________