Assalamualaikum WBT,
Dear Parents/Guardian _________________________________,
PARENTAL CONSENT LETTER FOR EARLY CHILDHOOD DEVELOPMENTAL
ASSESSMENT
         We, Psychology students of ___________________________________________________,
would like to request for your permission and consent to conduct a developmental assessment on your
child, ______________________________________. For your information, this assessment will be part
of our requirement to fulfil the course _______________________________________ under the
supervision of ______________________________________.
2.       The assessment will include testing on gross motor development, fine motor development and
perception development. The assessment will involve some activities with the child through play method.
Some background information about the child will also be collected through interviews with the
parents/guardian and/or the child.
3.       Throughout this assessment, we will ensure that we will hold strong to the ethical values of a
Muslim psychologists. The parents/guardian will hold the right to withdraw the child from the assessment
at any part of the assessment.
If you agree, please fill in the form below:
        I, ____________________________________________________________________________,
hereby agree to allow these students:
to conduct the Early Childhood Developmental Assessment on my child, __________________________.
I acknowledge that I have been given enough information and sufficient time to enquire about the
assessment.
Parent/Guardian’s Signature,
____________________________
Name:
Relationship:
Date: