Brain Bootcamp Registration Form

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Consent

Unfortunately, your responses indicate you are not eligible to participate in the study. If you have any queries please contact us, 9850 2210, or email info@brainbootcamp.com.au

Thank you for your interest in Brain Bootcamp Frontiers

The aim of our Frontiers program is to increase dementia awareness and decrease dementia risk in older adults living in rural communities. To proceed we need to ensure you understand the risks and benefits of the study.

I confirm that:

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* Please check at least the first SIX boxes. Please also click "Yes" to consent to participate.

* I have read the Participant Information Form and I understand the purposes, procedures and risks of the research described in the project. I have had an opportunity to ask questions and I am satisfied with the answers I have received.
* I freely agree to participate in this research project as described and understand that I am free to withdraw at any time during the project.
* I consent to being allocated to either the multidomain behaviour change group or the waitlist control group and understand that this allocation is not based on my survey responses, but is completely random.
* If I am in the multidomain behaviour change group I will undertake 4 online surveys every 3 months, as well as participate in 3 telephone-based cognitive function assessments separated across 9 months.
* If I am in the waitlist control group, I will undertake 5 online surveys every 3 months, as well as participate in 4 telephone-based cognitive function assessments separated across 12 months.
* I consent to having my health and personal data collected and authorise release of, or access to, my confidential information to the relevant study personnel and as noted in the information form.
I am willing to be contacted by researchers to participate in a 30-minute evaluation interview at the end of the trial (mid-2023).

Please confirm:

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Please select at least 2 answers

I confirm that I do not have a diagnosis of severe depression.
I confirm that I am not involved in any other lifestyle or brain health awareness program.

(This question is mandatory)

Do you consent to participate in the Brain Bootcamp Frontiers program?

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No

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