CNS 18 - 40 
6. I know that I/my child will not be paid for being in this study. 
7. I know that if I am injured/my child is injured because of this study, I/my child will 
not get any money for being injured. However, St. Jude will treat the injury, free of 
charge. 
8. I know that my/my child’s records will not be given to anyone outside the hospital 
unless I agree. I agree that my/my child’s records may be reviewed by agencies such 
as the Food and Drug Administration or the National Cancer Institute. 
9. I know that if I have more questions about this study or about any injury from the 
treatment, I can call at . 
10. I know that I can get more information about my/my child’s rights as a study 
participant by calling the Chairman of the Institutional Review Board at 901/522- 
0300. 
11. I will receive a signed copy of this statement. 
Patient 
Parent 
Physician 
Witness 
Date 
Time 
In case of questions or emergencies in reference to this protocol, please contact: 
St. Jude Children’s Research Hospital 
332 North Lauderdale 
Memphis, TN 38105 
(901) 522-0300 
Recombinant DNA Research, Volume 18 
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