DaddYoga Registration and Information Form - OhioGuidestone Research Portal

Electronic Agreement *

By checking this box, I agree to use electronic records and electronic signatures.

Date *

Father's Name *

First

Last

Email Address

If entered, we will email a copy of this consent to the supplied email address

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

We're asking for your address so we can send you and your child a special gift!

Number of Children Participating

Age of Children

How did your hear about DaddYoga? *

Which DaddYoga series are you attending?

Sundays (9-10am) July 10th, 17th, 24th, 31st
Sundays (9-10am) September 4th, 11th, 18th, 25th1st
Sundays (9-10am) November 6th, 13th, 20th, 27th10th, 17th, 24th, 31st

All sessions are free, and fathers can sign up for more than one.

Do you have any questions or comments to add?

You are being asked to participate in a voluntary part of this program called the DaddYoga survey study. This is a research study we were doing that uses surveys to see how fathers feel before and after DaddYoga sessions. The surveys are like satisfaction or feedback surveys you might complete after going to a doctor’s appointment, or after buying something.

You can still participate in DaddYoga even if you do not do the survey study. Your decision to participate or not participate in the survey study will not change how we treat or think of you.

There is no cost to the survey study. You will not receive anything extra for doing surveys, but you would be helping us learn how to improve and create new programs and services for fathers and their families.

You will complete a beginning survey when you sign up, or right before your very first DaddYoga session. Then you will complete a follow-up survey after each DaddYoga session. Surveys are short, and can be done on your phone, tablet, or computer. If you need to talk to someone more about your thoughts or feelings, we will be available to talk to you via phone, email, or video call. Or you can dial 211 to learn about different types of help in your local neighborhood.

We keep all of your information confidential and safely secure. Only people on our study survey team will have access to your contact information or surveys. We will remove your name and identifying information (email, phone number, address) from the survey to give you more privacy. Your answers will not change your participation, or our thoughts or treatment of you.

If you have any questions about the DaddYoga Survey Study you can contact the study leader, Brittany R. Pope via email or 440.260.8865. Or you can contact OhioGuidestone’s Client’s Rights Advocate at 440.260.8308.

DaddYoga Survey Study Participation: If you would like to help us learn more about how fathers feel before and after DaddYoga please check this box. *

Yes- I have read the information about this study and would like to participate by completing surveys before and after DaddYoga.
No- I have read the information about this study and do not wish to participate in completing surveys before and after DaddYoga.

Signature of Participant or Parent/Guardian *

This electronic signature holds the same force and effect as an in-person signature.