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CONSENT FORM FREE AND CLEAR (IC)
Title of research: Daily water consumption
Researcher (s), with addresses and telephone numbers: Alfredo Conceição Erdmann, Alison Antony Ribeiro - inventor of the Street 3323, (045) 984-167-843, (044) 999-890-114
Engineer or doctor or counselor or other professional responsible:
Site of the search: Medianeira - PR
Address, site phone:
A) THE PARTICIPANT INFORMATION
Presentation of research.
Drinking water is the name given to that water does not smell (odorless); no color (colorless) and has no taste (tasteless). For the consumer, it must possess these qualities, and if present preferably fresh, or pleasant temperature. It can be bottled or treated. Mineral water is one derived from natural sources or artificially captured sources, mineral underground waters return to the surface through natural or are extracted by wells drilled sources. Treated water is characterized in research as water provided by Sanitation Company of Paraná (SANEPAR) to the homes of population via the supply network.
Research objectives.
	
This research aims to identify the population's confidence in the treated water which is supplied by the supply company of the city of Mediatrix, and which ones people use on a daily basis for consumption treated water or mineral water.
Participation in the survey.
	
You are invited to participate in research that will be held in the questionnaire format defined, which will initially questioned the initial data the name, age and sex, then 5 questions to identify the confidence level in the treated water and what you most used on a daily basis.
Confidentiality.
The search guarantees of maintaining the confidentiality and privacy of the survey participants during all phases of the research; 
Discomforts, risks and benefits.
	
5a) or risks and discomforts:
The embarrassment of answering the questions in the questionnaire.
 
5b) Benefits:
	Through the data collected will be possible check population preferably water is indeed the best for consumption, thus improving water management for the population through information.
inclusion and exclusion criteria.
6a) Inclusion:
	Adults of both sexes, 18 years
6b) Exclusion:
	People under the age of 18 years.
Right out of research and clarification during the process.
	At any time during the survey researched may request clarification of the issue, and given the option not to answer the question, and also give up all answer the questionnaire. If you prefer, you can request your complete shutdown of the research, getting to each other the information already filled in to give the destination you prefer.
	
Reimbursement or compensation.
Not applicable.
 
B) CONSENT (the research subject or legal guardian - in this case attach document proving parentage / guardianship / trusteeship)
I declare that I have knowledge of the information contained in this document and have received clear answers to my questions on the subject of my direct participation (or indirect) in research and additionally declare that I have understood the purpose, nature, risks and benefits of this study. 
After reflection and a reasonable time, I decided, freely and voluntarily participate in this study. I am aware that I can leave the project at any time without any damage.
	
	
	
Full name:___________________________________________________________________
	RG: _____________________ Date of Birth: ___ / ___ / ______ Phone: __________________
	Address: _________________________________________________________________________ ZIP Code: ___________________ City: ____________________ State: ________________________
	
Signature: ________________________________
	
Date: ___ / ___ / ______
I declare that I have presented the study, explained their objectives, nature, risks and benefits and have responded in the best possible way to the questions asked.
	
Signature researcher: ________________________
(Or its representative)
	
Date: ______________________________
	
Full name:___________________________________________________________________
For all questions relating to the study or to withdraw from it, may communicate with ___________________________, via e-mail: __________________ou phone: _______________.
Address of the Research Ethics Committee to appeal or complaints from research subject
Ethics Committee of the Universidad Tecnológica Federal do Paraná (CEP / UTFPR)
REGENTS: Av Sete de Setembro, 3165, Rebolledo, CEP 80230-901, Curitiba-PR, Tel:. 3310-4943, e-mail: coep@utfpr.edu.br
NB: This document must contain two identical copies, one belonging to another researcher and the research subject.
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