HFM Healthy Joint Initiative

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It is important for individuals with bleeding disorders to participate in some form of physical activity. Being physically active helps to strengthen one's muscles, bones, and joints. One of the many benefits of having a strong, healthy body can be a reduction in the number of joint bleeding episodes an individual might experience. That's why HFM has created the Healthy Joint Initiative. By signing up for this initiative, HFM members will receive the following:

-a Healthy Joint Initiative Welcome Package and t-shirt
-a directory of easy and safe physical exercises for different muscles to improve joint health and ways to modify those exercises during a bleeding episode.
-Invitation to HFM-sponsored fitness and health activities to be held throughout Maryland from June - to September.
-up to $250 in funding payable directly to the program for bleeding disorder patients to enroll in healthy joint physical activities such as (1) swim lessons, (2) golf lessons, (3) yoga, (4) taekwondo, etc. Funds are limited. Submitting an application does not guarantee approval of funding. Funding requests will be reviewed individually, and applicants will be notified of HFM's decision within 14 days.

Thank you to our Healthy Joint Initiative Program Sponsors: Takeda, CSL Behring & Genentech

Email *

Bleeding Disorder Member's Name: *

Bleeding Disorder Member's Date of Birth: *

YYYY

Diagnosis: *

Hemophilia Mild

Hemophilia Moderate

Hemophilia Severe

vWD Type 1

vWD Type 2

vWD Type 3

Platelet Disorder

Other:

T-shirt Size *

Youth XS

Youth Small

Youth Large

Youth XL

Adult Small

Adult Medium

Adult Large

Adult XL

Other:

If member's is a minor, Bleeding Disorder Patients Parent(s) Name(s):

Mailing Address: *

City: *

State *

Zip *

Mobile Telephone Number: *

Email: *

Activity your are interested in receiving a joint healthy activity scholarship for: *

Swimming Lessons

Golf Lessons

Yoga

Taekwondo

Other:

Location of where you would like to sign up for the above activity: *

Name of the Hemophilia Treatment Center you Attend? *

Johns Hopkins

Children's National Medical Center

Georgetown

Christiana

Other:

Name of your Hematologist (bleeding disorder doctor) *

WAIVER: I am an individual with a congenital bleeding disorder or a parent of a minor child with a bleeding disorder applying for HFM's Healthy Joint Initiative Program. I authorize the release of information to the Hemophilia Foundation of Maryland in order to verify all statements made in this application. I also give permission to use my name and/or photo in HFM's website, HFM News, or any other press release that HFM deems appropriate. *

I agree with the above statement and by checking this box consent to the above

I disagree and do not consent to the above.

Required

Date I am submitting this form: *

YYYY

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