Megan Justine Fitness - Interest Form

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Megan Justine Fitness - Interest Form

Email *

Full name *

Phone number *

Email *

Age *

Please explain in detail any pre-existing health conditions that may effect your ability to exercise. *

Are you looking for at home or in-gym workouts? *

Home

In-Gym

If you chose home, what equipment (if any) do you have available to you? *

What are you currently doing for fitness? Please include type of exercise and frequency. *

Please rate your exertion during your current workouts. *

Very Light Activity

Light Activity

Moderate Activity

Vigorous Activity

Very Hard Activity

Max Effort Activity

What are your current fitness goals, or what are the changes you would like to make in your fitness/lifestyle?

Please be specific!

Please give a brief description of your current nutrition, include any diet plans/restrictions you follow. *

Acknowledgement for Use

By checking the box below you acknowledge the following:

Megan Hampton is not a doctor nor registered dietician, and participating in this program is to be done at your own discretion. I acknowledge that I have carefully read this Waiver and Release, and fully understand that it is a release of liability. I expressly agree to release and discharge Megan Justine Fitness and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, representatives, predecessors, successors and assigns, from any and all claims or causes of actions, and I agree to voluntarily give up or waive any right that I otherwise have to bring legal action against meganjustinefitness.com for personal injury or property damage.

In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

In the event that any damage to equipment or facilities occurs as a result of my willful actions neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of negligence or recklessness.

I also acknowledge that there are no refunds, returns, or exchanges. Once I made my purchase, the transaction was finalized and I am held financially responsible for my purchase. Any attempt to return or request refund will result in legal action taken against me.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of Megan Justine Fitness or its agents in its employees.

Legal actions will ensue if refunds are requested via any method.

I, the applicant for this Waiver and Release of Liability, warrant and represent that I understand and accept this Waiver and Release of Liability.
*

I agree

I do not agree

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