Sugar-Free Living Challenge Registration

Welcome
Welcome to the Sugar Free Living Challenge. Please fill out the details below in order to register for the challenge.

If you have already filled out the form by email please do not fill out the registration again. You can learn more about the challenge by visiting http://sugarfree.jcscwellness.org/

Thank you.
JCSC Wellness Committee.

First Name
Your answer
Last Name
Your answer
Phone number
Your answer
Age
Your answer
Gender (M/F)
Required
Height (in inches)
Your answer
Weight (in lbs)
Your answer
Email
Your answer
Referred By
Your answer
Consent to participate in wellness challenge and Waiver of Liability
Consent to participate in wellness challenge and Waiver of Liability

By submitting the form, I understand, acknowledge, and agree to the following:
I am voluntarily participating in this Wellness Challenge. I will take necessary professional medical advice for participation. I agree to indemnify and hold harmless the Organization and Volunteers from any and all claims, liability and expenses (including attorneys fee and court costs) arising out of advice given or not given, tests conducted or any act or inaction on the part of the Organization or the Volunteers or any of them, during or after this Health Screening. If you do not agree or wish to not participate in this challenge, please ignore this email.

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