6 Week Nutrition Challenge: REGISTRATION
FALL TRANSFORMATION CHALLENGE STARTS: 9/27/2021; KICK-OFF SEMINAR 9/25/2021 @ 9:45am
By submitting this form, I authorize Sarge Athletics 2 LLC, dba Sarge Athletics, to initiate debit entries to the checking/credit card account on file or provided herein in the amount(s) indicated below.
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First and Last Name of Participant
PAYMENT METHOD: Card holder Name, Card Number, Expiration Date OR write card on file.
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Participation Disclosure & Release: I agree (or for athletes under age 18, agree to allow the minor in my custody/care) to participate in a physical fitness and/or nutrition program with a trainer or trainers of Sarge Athletics 2 LLC, DBA SARGE ATHLETICS (“SA”). I recognize that exercise is not without varying degrees of risk to the musculoskeletal and/or cardio respiratory systems. I hereby certify that I know of no medical problems that would increase Member’s risk of illness and injury as a result of participation in a physical fitness or nutrition program with SA. I understand and have been informed that there exists the possibility of adverse changes during the exercise program. Member has been informed that these changes could include abnormal blood pressure, fainting, disorders of heart rhythm, stroke, and very rare instances of heart attack or even death. Members with pre-existing medical conditions including but not limited to, the conditions listed and/or those with any general health concerns should consult with an appropriate healthcare professional before beginning any SA program. Member acknowledges nutrition services are not to be in place of any medications. Member understands the Member is responsible to seek independent advice from a healthcare professional before participating in any in-person or online program including but not limited to, acting on fitness instruction/advice and/or nutrition services/tips offered by SA at its Training Center or on its Website, affiliated apps, or social media channels. • Pregnant women and women who are breastfeeding or who are trying to conceive a child; persons with any ongoing physical condition such as: cancer or other long term illness; liver disease, kidney disease, or renal failure; a history of eating disorders; persons with diabetes, blood pressure or cholesterol issues. Online/virtual services may not include any supervision or monitoring of Member activity, and SA is not responsible for any injuries that Member may sustain as a result of following the exercise program or nutrition program on its website, exclusive or third-party apps, or social media content. If Member is unable to complete the exercise or follow nutrition tips due to physical limitation or lack of understanding DO NOT attempt. If Member does attempt, Member will be liable for any injury sustained. Photo Release: I hereby authorize SA and its affiliates to use, reproduce, and/or publish all written and/or visual materials, including photographs that may pertain to me. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I understand that this material may be used in various publications, public affairs releases, recruitment materials, or for other related endeavors. This material may also appear on the corporation's or project sponsor's internet web page. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization provided to Sarge Athletics in writing and attached to this agreement. Consequently, SA or its affiliate(s) may publish materials, use my name, photograph, video and/or make reference to me in any manner that the corporation or project sponsor deems appropriate in order to promote/publicize its services.Returning this form to Sarge Athletics 2 LLC, via written or electronic media shall constitute conclusive proof that I agree to the terms and conditions of this Disclosure and Release form. I acknowledge my responsibility to retain a completed copy of this Agreement for my records.
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