On-Line Consent Form




Participant Information

Contact Information

Kyle's Home Page

Name (required):

Street Address (required):

Additional Address Line: 

City (required): 

State (required): 

Zip Code (required): 


Phone Number (xxx)xxx-xxxx: 

Fax Number (xxx) xxx-xxxx: 

email (required): 


I agree to participate in a research study exploring the experience of being-with in an on-line in a multi-user game as described in the attached narrative. I understand the purpose and nature of this study and am participating voluntarily. I am above the age of eighteen. I understand if I am not above the age of eighteen I need my parents consent. I grant permission for the data to be used in the process of completing a Psy.D. degree, including a dissertation and any other future publication. I understand that my real name and other demographic information which might identify me will not be used. I also understand that my on-line alias will not be used. I understand that I may withdraw my consent at anytime. I also grant permission for the recording of the interview(s) by the use of electronic logs.



I have read the above and willingly give my consent to participate by clicking this box.