Longwood University
Consent for Participation in Social and Behavioral Research


I consent to participate in the research project entitled: Evaluating Parent-Child Involvement Activities in a Domestic Violence Center

being conducted in the Department of Sociology, Anthropology, and Criminal Justice Studies by

Haley Schultz 

  • I understand that my participation in this research is voluntary, and that I am free to withdraw my consent at any time and to discontinue participation in this project without penalty.
  • I acknowledge that the general purpose of this study, the procedures to be followed, and the expected duration of my participation have been explained to me.
  • I acknowledge that I have the opportunity to obtain information regarding this research project, and that any questions I have will be answered to my full satisfaction.
  • I understand that no information will be presented which will identify me as the subject of this study unless I give my permission in writing.
  • I acknowledge that I have read and fully understand this consent form. I sign it freely and voluntarily.  A copy of this form will be given to me.

Name (Print): _________________________________________
Date: _________________        Signed: ________________________


I understand that if I have concerns or complaints about my treatment in this study, I am encouraged to contact the Office of Academic Affairs at Longwood University at (434) 395-2010.









Family Fun Times Activities

This survey will be used to analyze if the Family Fun Times Activities promoted family engagement and involvement. Your feedback is very important in evaluating and improving this program.

1.How many families participated in the activities? ___________________

2. What is the general age ranges of the children who participated? __________________

3.Were the activities inclusive in terms of gender and age? If any were not please explain.
4. Do you feel as though the activities were age appropriate? If not explain which activity and why.

5. What was the average time taken on the activities? ________________

6. Did any problems arise when completing the activities? If yes, what types of problems?

7. Did the participation in these activities cause any type of distress/agitation? If so why?

8. Were the parents engaging with the children?  (helping them or letting the child/children to do it by themselves) If yes how so?

9. Do you think that the activities helped the parent/child relationship? In what ways do you think that the activities helped?
10. What activities did you observe?


11. What activities were the most popular?

12. What did you like about the activities?

13. What did you dislike about the activities?

14. What specifically would you change about the activities?

15. Do you feel that the activities promoted parental engagement? If yes, how? If not what would you recommend doing that would promote parental engagement?

16. Do you feel as though the activities were trauma informed? Please explain why or why not.

17. Were these activities helpful for your organization? If yes, in what ways? If no why not?

18. Would you want to keep activities like these at Madeline’s House? Are there any activities you would want to have if we proceeded to supply Madeline’s House with activities?