Baseline Survey

: January 2016
Study Name: Understanding the role of parents in supporting physical activity among children and youth with disabilities
 Rebecca Bassett-Gunter, PhD
 York University
 Kinesiology & Health Science
 Phone: (416)736-2100 x22072
 Kelly Arbour-Nicitopoulos, PhD  
 University of Toronto 
 Kinesiology & Physical Education 

  Phone (416) 978-2725 
 Ryan E. Rhodes, PhD 
 University of Victoria
 Behavioural Medicine 

 Phone (205) 721-8384 
Purpose of the Research: The purpose of the research is to examine and enhance our understanding of the role of parental support in facilitating physical activity participation among children and youth (5-21 years) with disabilities.
What You Will Be Asked to Do in the Research: You will be asked to complete two online questionnaires. The first questionnaire will take 15-minutes to complete and the second questionnaire will be administered one-month later and will take 5-minutes to complete. As a token of appreciation, we will send you one $10 CAD gift card for completing the questionnaires.
Risks and Discomforts: We do not foresee any risks or discomfort from your participation in the research.
Benefits of the Research and Benefits to You: The information gained from this research will help to build a better understanding of the role of parents in supporting their child with disabilities in being physically active. This information may assist with the development of programs and policies regarding physical activity among children and youth with disabilities.
Voluntary Participation: Your participation in the study is completely voluntary and you may choose to stop participating at any time.  Your decision not to volunteer will not influence the nature of your relationship with York University either now, or in the future.
Withdrawal from the Study: You can stop participating in the study at any time, for any reason, if you so decide. If you decide to stop participating, you will still be eligible to receive the promised honorarium for agreeing to be in the project. Your decision to stop participating, or to refuse to answer particular questions, will not affect your relationship with the researchers. York University, or any other group associated with this project. In the event you withdraw from the study, all associated data collected will be immediately destroyed wherever possible.
Confidentiality: All information you supply during the research will be held in confidence. Your name or any information that can be identified with you will not appear in any report or publication of the research. Data will be collected using a secure online data collection system. Your data will be safely stored on a password protected system and only research staff will have access to this information. After study completion, the data will be stored on a password protected computer, which will be locked in the Dr. Bassett-Gunter’s research office. The data will be stored for a minimum of 7 years after data publication and then will be destroyed. Confidentiality will be provided to the fullest extent possible by law.
Questions About the Research?  If you have questions about the research in general or about your role in the study, please feel free to contact Dr. Bassett-Gunter either by telephone at (416) 736-2100, extension 22072 or by e-mail This research has been reviewed and approved by the Human Participants Review Sub-Committee, York University’s Ethics Review Board and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines.  If you have any questions about this process, or about your rights as a participant in the study, please contact the Sr. Manager & Policy Advisor for the Office of Research Ethics, 5th Floor, York Research Tower, York University (telephone 416-736-5914 or e-mail
Legal Rights and Signatures: I consent to participate in Understanding the role of parents in supporting physical activity among children and youth with disabilities conducted by Rebecca Bassett-Gunter
. I have understood the nature of this project and wish to participate. I am not waiving any of my legal rights by signing this form. By clicking the “I consent” below, I indicate my consent.
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