Department of Children and Youth - Interview Consent Form

Leave This Blank:

Dear Parent or Guardian,

The City of Richmond’s Department of Children and Youth would like to invite your child to share their thoughts about programs available for children and youth by taking part in an interview. The Department of Children and Youth is collaborating with community organizations across Richmond and North Richmond and is working with Hatchuel Tabernik & Associates (an independent consulting group) to assess the resources and needs of youth so that City resources can be allocated to serve them.

Interviews: We plan to conduct an interview to help us learn more about youth and their perspectives on programs, to get their input, and hear about what resources they would like to see. Your child is invited to participate in this discussion to answer questions about their experience. The interview is expected to take about 30 minutes and will be recorded so that we may listen attentively to your child during the discussion and take notes.

Confidentiality: The goal is to gather information about programs, not your child. The moderator (either staff from the City of Richmond or from Hatchuel Tabernik & Associates) will not gather or use full names to identify participants and your child’s feedback will remain confidential. No comments will be connected with any child’s name in our analysis and reporting. We hope that the interview will provide us with insight into how programs for children and youth can be enhanced to help all children and youth in Richmond and North Richmond.

Voluntary Participation: Your child’s participation in this interview is voluntary. Your child is free to refuse to take part, and may refuse to answer any of the questions, or may stop participating at any point. (However, youth often report that they find the experience fun!) Whether your child participates or not will have no bearing on their standing at school or in any programs in which they currently participate.

Award: After completion of the interview, each participant will receive a $75 Target gift card for their participation.

If you agree to allow your child to participate in this interview, please sign, date, and submit below.

Thank you very much,

Department of Children and Youth

Contact information:
Phone: 510-620-6523

* indicates required fields.