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Intake Form for 6 WEEK $247.00 SPECIAL W/O SUPPLEMENTS
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District of Columbia
Date of Birth
6 WEEK $247.00 SPECIAL
New Challengers weight:
Goal Weight (Todays weight, less 20lbs):
Terms of Service for the Challenger Agreement and Commitment
I have read and agree to the Terms
Terms of Service
CHALLENGER AGREEMENT AND COMMITMENT
1. A successful body transformation entails weight loss on OUR company’s scale.) We reserve the right to terminate your agreement for lack of compliance. If you do not comply with the program. (e.g. miss workouts, do not follow nutrition and supplementation plan as outlined in this event, we will NOT issue a refund.)
2. You understand that you must complete five (5) days of Travis Garza workouts per week (Camp or YouTube Workout and that each day you must check-in and tag Bernadette and Pat on Facebook and write a short sentence or post picture.
3. You must text toes on scale weight on Sundays and Wednesdays.
4. Photos and videos are regularly taken during workout sessions to be used to inspire others and encourage a healthy lifestyle. All photos and videos are displayed on social media outlets to motivate others to work hard to achieve their goals. As such, all members agree to allow their pictures and videos to be posted to social media outlets.
5. You must change your Facebook profile picture to the red “G” picture for the entire 6 Week Challenge.
6. The meal plan that you will receive belongs to Travis Garza and TLC Fitness. It is NOT to be shared with anyone. If we discover that you have distributed or shared the meal plan, you will be removed from the Challenge and will NOT receive a refund.
7. We believe our clients are my best advertisement. We strive to do everything in our power to push our clients to be their best. By initialing, you agree to let us push and motivate you the best way we know how.
8. If you are a returning 6 Week Challenger within the past 12 months, your starting weight for this Challenge will be your most recent final weigh-out weight plus 5 pounds if you weigh more than your previous final weigh in weight.
9. WE ONLY WANT TO WORK WITH MOTIVATED “A” PLAYERS – not talkers or pretenders. BY SIGNING AND INITIALING this agreement, there is NO backing out or cancellation!!! The $347 is nonrefundable FOR ANY REASON. If you have any hesitations, do us both a favor and DO NOT ENROLL.
EMERGENCY CONTACT INFORMATION
Emergency Contact Information: Name
6 WEEK CHALLENGE AGREEMENT - PROTEIN AGREEMENT
Why you MUST drink a protein drink twice a day! This is NOT an option on this program
1. Possesses the highest Thermal Effect of Feeding of any nutrient. Translated: EATING protein burns calories because protein requires more energy to digest than any other nutrient. 2. Helps offset the negative effects of insulin by stimulating the release of Antagonistic Hormone Glucagon. Translated: Ample protein intake makes carbohydrates much less likely to affect your waistline. 3. Protein is critically important to building, repairing, and maintaining lean muscle tissue. You are NOT getting enough protein through your diet alone… I promise you!
6 WEEK CHALLENGE AGREEMENT - NO ALCOHOL CONTRACT
I (type name below),
understand that if I drink ANY alcohol during the 6 Week Challenge I will be removed from the program without a refund.
PAYMENT PLAN AND PACKAGE OPTIONS
Check one (1)
A. Pay in Full - $247.00
I (type name below), (copy)
hereby authorize “Indiana Fat Loss Camp” to charge my credit card or debit card any and all payments as indicated below. I further authorize my credit card company or bank to make payment to” Indiana Fat Loss Camp” by the method indicated below and to post it on my account.
I agree to hold harmless Travis Garza/TLC Fitness, Inc., and all of his employees or agents free from any and all injuries, losses, damages, and liability occurring from my participation in the activity for which I have enrolled. I also agree to be photographed/videotaped and release the use of the photographs/videos for publicity in “Indiana ‘Fat Loss Camps’ and TLC Fitness, Inc.’s publications and other marketing tools.
Stripe Credit Card
Name on Card
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