• I have been thoroughly informed concerning the studies

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I have been thoroughly informed concerning the studies „PROVABESPROspective Validation of Biomarkers in Ewing Sarcoma” and “EECEuropean Ewing Consortium”. The planned analyses and necessary
extractions of blood and bone marrow, as well as tumour removal have
been explained to me.
I have read and understood the information form. All of my questions were
sufficiently answered by my contact persons.
I consent that data collected in the context of these studies is used in a
pseudonymous way for analyses. Material from tumour, blood and bone
marrow shall be examined for genetic and epigenetic changes. If
necessary, data will be transferred to appropriate authorities. I understand
that legally my data must be accessible to appropriate authorities. The
appropriate authorities are: N.N.
Furthermore for study verification purposes, I consent that an authorized
person who is bound by confidentiality is granted access to my data.
As the studies take place in several countries, I consent that for verification
reasons my data will be transferred in a pseudonymous way to foreign
appropriate authorities, and that a foreign authorized person who is bound
by confidentiality is granted access to my data.
I consent to the transfer of biomaterial to the following scientists and
laboratories:
- Professorin Uta Dirksen | Universitätsklinikum Münster |Pädiatrische
Hämatologie
und Onkologie | Albert-Schweitzer-Campus 1 A1 |48149 Münster
- Professor Heinrich Kovar | St. Anna Kinderkrebsforschung e.V. |
Zimmermannplatz 10 |
1090 Wien | Österreich
- Professor Olivier Delattre| Institut Curie|26 rue d`Ulm | 75248 Paris
Cedex 05| Frankreich
- PhD Katja Scotlandi und Professor Piero Picci | Istituto Ortopedico Rizzoli
| Via di Barbiano
1/10| 40136 Bologna| Italien
- Professor Enrique de Alava | Hospital Universitario Virgen del Roío | Avda.
Manuel Siurot
s/n | 41013 Sevilla | Spanien
- Professor Stefan Burdach | Technische Universität München |
Kinderklinik München
Schwabing | Kölner Platz 1 | 80804 München
- Professorin Sue Ann Burchill | Children`s Cancer Research Group,
University of Leeds |
LS97TF Leeds | UK
- Professor Markus Metzler | Universitätsklinikum Erlangen | Kinder- und
Jugendklinik,
Abteilung Onkologie und Hämatologie |Loschgestraße 15| 91054
Erlangen
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I would like to have the following questions resolved:
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Yes, I consent to participating in these studies. My participation is voluntary and
free of charge. I understand that I am free to withdraw my consent at anytime.
My/our decision is not disadvantageous to me or my child.
No, I do not want to participate in these studies. My/our decision is not
disadvantageous to me or my child.
Date