Registration for Program

Terms and Conditions

1. I must be capable of self-care including eating, showering, dressing, walking, administering medications to myself, etc.

2. An informed consent and release of liability waiver must be signed upon arrival.

s3. I understand that to make a reservation I need to give a deposit of 10% of the cost of the program or the cost of the program (depending on date of registration) and that is non-refundable after 72 hours, but it can be applied to an upcoming program within a year from date of payments made.

4. Any remaining balance is due 2 weeks prior to the program start date, this balance is non-refundable but may be transferred under special circumstances.

5. There is no 24/7 medical personnel available in the facility. I’m responsible to administer my medication, monitor glucose, as needed.

6. If hospitalized, must be 3-4 weeks post-hospitalization before acceptance to participate in any program.

7. No refund of money is given if you arrive at the lifestyle center in a worse condition than what was in the application.

8. I attest that my health condition is true to the best of my knowledge By submitting the below registration, you agree with the above terms and conditions: 8. I attest that my health condition is true to the best of my knowledge By submitting the below registration, you agree with the above terms and conditions: please check for signature

First Name

Last Name

Birthdate

Weight

Height

Mailing Address

City

State

Zip Code

Email Address

Phone Number

Goal for coming

List any current health/medical condition

List of current medications / supplements

List any food and medication allergies

Religious preference

Notes

6 + 2 =

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If you are interested in joining our session, send us an inquiry and we will get back to you as soon as we can!

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