FocusJr

Name

Telephone number

Address

City

State

Zip code

Email address

What is your job title or position?

What is your current age?

What is your current working status?

Work full time
Work part time
Stay at home parent
Unemployed
Full time student
Student with part time job

If you selected "Student" on the previous question, what school do you attend?

Do you participate in any sports activities?

Yes
No

If you participate in sports, what activities do you regularly participate in?

Choose all that apply

Soccer
Football
Hockey
Basketball
Baseball
Tennis
Track
Cross Country
Swimming
Wrestling
Running
Weightlifting
Aerobics or Bootcamp
Yoga
Other

If you selected "Other" on the last question, please specify:

What would you consider your primary sport? Or the sport most important to you?

Do you play any team sports and are part of a league, organization or high school?

Yes
No

Do you play your primary sport in the league or organization in which you participate?

Yes
No

What is your gender?

Which of the following best describes your ethnic background?

White or Caucasian
African American
Asian American
Native American
Hispanic/Latino
Bi-racial
Other

What is the name of your High School?

Do you have a track coach?

Yes
No

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