Jumpstudy Interest Form

If you have read the DO YOU QUALIFY page for the study carefully and you DO qualify for participation, please complete the form below to be placed on our interest list for Cohort 5 that begins in mid-August, 2011. If you plan to enroll for academic credit, we will provide you the KINE 499 Independent Study form to enroll at your pre-test appointment.

Thank you again for your interest!

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Contact Information

*Last name

*First name

*Email

Home phone

Cell phone

Can you receive text message reminders for appointments?

Yes

Preliminary screening information

*Age

*How many menstrual cycles have you had in the past year (average is 10-12 periods/yr)?

*Are you pregnant or do you plan to become pregnant in the next year?

*Do you smoke?

*Have you participated in REGULAR high-impact activity in the past year (gymnastics/plyometrics/volleyball/basketball)? Running is fine.

*Do you take medications that affect bone like diuretics/blood pressure drugs/cancer/osteoporosis medications

*Approximate height (inches)

*Approximate weight (lbs)

*Do you take birth control pills or use Depo Provera for birth control?

using hormone medications will not affect your ability to participate in the study but we ask that you continue using your current medication throughout the study.

*Are you willing to commit to jumping off of a 4 to 12-inch step 3 times per week at home for the next 9 months?

Any additional comments/questions? (optional)

Submit