6 Week Online Weight Loss and Fitness Class Disclaimer Form

WEIGHT LOSS & EXERCISE CLASS PARTICIPANT AGREEMENT

I ________________________________ have received and agree to the rules of the Weight Loss & Fitness Class.

I understand that the non-refundable participant fee of thirty dollars ( US $30.00) entitles me to participate in the 6 week weight loss and fitness class, which begins the week of _______________ and ends ___________________.

I agree to attend for 6weeks with the online group. I agree to weigh and take my measurements every week and submit them. I will also take a before and after picture (optional). I also understand that if I choose to drop out of the class, I am entitled to NO refund for any money paid to the online weight loss & fitness class.

Health related topics found in the handouts, should not be used for diagnosing purposes or be substituted for medical advice. As with any new or ongoing treatment, always consult your professional healthcare providers before beginning any new treatment. It is your responsibility to research the accuracy, completeness, and usefulness of all opinions, services, and other information found in this class, and to consult with your professional health care provider as to whether the information can benefit you. Ruth Badraun and Rich Ridler assume no responsibility or liability for any consequence resulting directly or indirectly for any action or inaction you take based on or made in reliance on the information, services, or material on or linked to this site.

I _____________________________________agree to these terms on this

Date: _____________________ E-Mail_________________________________

Phone: _____________________

Address:_____________________________________________________________

Street City Province/State Postal Code/Zip

Payment:

There is US $ 30.00 non refundable entry fee for the class.

Please pay by PayPal or Credit Card to:

PLEASE PRINT THIS PAGE AND FAX IT TO 518-687-2708 OR SCAN AND SEND AS AN ATTACHMENT TO info@brfwellness.com

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