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Online Weight Loss Program Registration
How do you prefer our staff to contact you?
Other (please specify)
What are your goals?
Lose weight/ fat
Improve physical fitness
Have more energy & vitality
Get control of eating habits
Physique competition/ modeling
Improve athletic performance
Please list any significant medical condition diagnosed currently or in the past:
Are you taking any medications (over the counter or prescribed)?
Yes (Provide Name /reason)
Do you have any food allergies?
What foods do you not eat (don't like)?
Do you have any allergies to herbal supplements?
How many bowels movements do you have in a day?
How much water do you drink in a day?
List three of your favorite vegetables:
What types of meats do you eat?
What types of fish/seafood do you eat?
Do you have any Injuries?
Date of injury:
Please explain cause:
Acknowledge that Reinvent U Boot Camps will provide nutritional, fitness and coaching information and is not licensed or certified to prevent, diagnose, alleviate or treat any medical conditions, diseases, physical or mental ailments, pain or infirmities. The information in this program is meant to supplement, not replace, medical advice.
Acknowledge that before you begin any weight loss or fitness program, or change your nutritional regimen, you will consult your physician or other licensed healthcare practitioner to ensure that you are in good health and that these services will not harm you.
Acknowledge it is your responsibility to vet all foods/herbal supplement for ingredients that may present personal adverse reactions.
Acknowledge that you are responsible for contacting your physician to obtain medical clearance prior to beginning of the Reinvent U Weight Loss Online Program if you have a pre-existing medical conditions.
Acknowledge that related fitness/sports are an extreme test of one’s mental and physical limits and carry with it potential for damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of event/activities including the elements of a natural environment that they are fit, and they have regular medical physician they can contact regarding any medical problems that they might develop.
While people generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and healthy nutrition; acknowledge and agree that no warranties/guarantee,representations of my results or protection from future illness as a result of participation in this program have been made to me.
Acknowledge that the coaching relationship is not psychotherapy, psychological counseling, or any type of therapy; nor is it substitute for these services. I understand I am responsible for all my decisions, actions, and feelings.
Acknowledge if you falsify or omit information requested of you, you can be dismissed from the Reinvent U Online Weight Loss Program immediately with no monetary reimbursement.
Acknowledge the agreement of confidentiality with respect to Reinvent U Online Weight Loss Program and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, and any/all aspects of Reinvent U Online Weight Loss Program with non-customers, competitors or organizations.
You agree to be financially responsible for all purchases made by you or someone acting on your behalf through the website. You agree to use the website and to purchase our programs, products or services through the website for legitimate purposes only. You also agree not to make any purchases for speculative, false or fraudulent purposes or for the purpose of anticipating demand for a particular product or service.
You release Reinvent U Boot Camps LLC and our affiliates from any damages that you incur, and agree not to assert any claims against us or them, arising from your purchase or use of any programs, products or services made available by third parties through the website.
Acknowledge that I have volunteered to participate in the Reinvent U Online Weight Loss Program under the direction of Reinvent U Boot Camps LLC, which include, may not be limited to fitness, nutrition, and coaching services. In consideration of Reinvent U Boot Camps LLC agreement to assist me, I do here and forever release and discharge and hereby hold harmless Reinvent U Boot Camps LLC and respective agents, heirs, assigns, independent contractors, coaches, and employees from any and all claims, demands rights of action or causes action, present or future, arising out of or connected with my participation in the Reinvent U Online Weight Loss including any injuries resulting there from.
Acknowledge and irrevocably grant Reinvent U Boot Camps LLC, its assigns, and successors, my consent and full right to use my name, photograph, video, likeness, image, and voice in any and all media, social network, publications advertising, and publicity without compensation in connection with my participation in the Reinvent U Online Weight Loss Program through Reinvent U Boot Camps LLC.
The undersigned agrees that this is a full agreement between the parties, that Reinvent U Boot Camps LLC, nor anyone else has verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion. I have read this entire document and I understand and agree to all the terms outlined.
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