Tribe Membership

Intake Form - Step 1 of 2

DATE *

CUSTOMER INFORMATION

SHOCKFAT N.W. INDIANA TRIBE MEMBERSHIP AGREEMENT AND LIABILITY FORM. Please fill out COMPLETELY and PRINT CLEARLY.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

I (type name below), AUTOMATIC MONTH-TO-MONTH *

Phone Number *

Email *

Confirm Email

Date of Birth *//

TRIBE OPTIONS SELECT ONE

6 MONTH COMMITMENT *

NOW $69.00 - (6-MONTH COMMITMENT)
NOW $59.00 - (12-MONTH COMMITMENT)

Seniors over 65 years will need to contact office to get discounted rate Effective immediately.
Unlimited livestream and camp classes, eating plan and supplement plan.

Total

$ 0.00

FOR BILLING QUESTIONS please e-mail: garzashockfat@gmail.com

Initial, AUTOMATIC MONTH-TO-MONTH: *

The Tribe Membership will automatically go to month-to-month and be considered active after it has been completed, until cancelled as described in the Cancellation Policy. *

I AGREE

Initial, CANCELLATION POLICY AND EARLY CANCELLATION PENALTY: *

Indiana Garza Fat Loss Camp member MUST give 30-day notice of cancellation by completing cancellation form under Forms on Shockfat.com under the Membership tab and filling out the Garza’s Membership Cancellation form. E-mail the completed form at least 30 business days from the above-stated debit date to stop future payment. I understand I am responsible for all membership fees and charges to my account through that date.(Please note: Even if you notify administration/instructor verbally or text of your intent to cancel, you are still required to submit a completed “Cancellation Form” via e -mail at garzashockfat@gmail.com . Save a record of your submitted “Cancellation Form” e-mail as your receipt. If for any reason, you cancel before completing the agreed-upon 6 or 12 month agreement, a $50.00 fee will be accessed for early cancellation. I certify that I have fully read and understand this Agreement and will comply with the contents herein. *

I AGREE

Initial, *

INDIANA GARZA FAT LOSS CAMP MEMBER/PARTICIPANT ACKNOWLEDGMENT AND ASSUMPTION RISK AND RELEASE FROM LIABILITY OF I GARZA FAT LOSS CAMP, SHOCKFAT.

I have read and agree to the Terms

PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVE THE INHERENT RISK OF PHYSICAL INJURY OR OTHER DAMAGE,INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES.

PARTICIPANTS ACKNOWLEDGES THE RISK OF EXPOSURE OF VIRAL OR BACTERIA PATHOGENS FROM OTHER PARTICIPANTS OR OBJECTS IN FACILITY.

PARTICIPANTS FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A GARZA CAMP MEMBER SLIP, FALL BY GARZA FAT LOSS CAMP MEMBER, OR AN UNKNOWN HEALTH PROBLEM OF GARZA FAT LOSS CAMP MEMBER.

PARTICIPANTS AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES AND EXPOSURE OF VIRAL OR BACTERIAL PATHOGENS. GARZA'S FAT LOSS CAMP MEMBER AFFIRMS

PARTICIPANT IS IN GOOD PHYSICAL HEALTH AND DOES NOT SUFFER FROM ANY DISABILITY OR VIRAL INFECTION THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES.

PARTICIPANTS ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, GARZA FAT LOSS CAMP MEMBER AGREES THAT.

IT IS THE RESPONSIBILITY OF PARTICIPANTS TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF MEMBER/PARTICIPANT TO TAKE PART IN INDIANA GARZA FAT LOSS CAMP ACTIVITIES.

BY AGREEING TO AGREEMENT. INDIANA GARZA FAT LOSS CAMP MEMBER/PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES.

INDIANA GARZA FAT LOSS CAMP MEMBER/PARTICIPANTS AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.

Initial *

I hereby grant Indiana Garza Fat Loss Camp permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Indiana Garza Fat Loss Camp in perpetuity, and for other use by Indiana Garza Fat Loss camp. I will make no monetary or other claim against Indiana Garza Fat Loss Camp for the use of the photograph(s)/video. *

I AGREE

BY SIGNING THIS YOU AGREE TO THE TERMS ABOVE.

AUTOMATIC PAYMENT AUTHORIZATION:

I (type name below), hereby authorize Indiana Fat Loss Camp to charge my credit card or debit card *

CARD TYPE

AMEX
DISCOVER
MASTERCARD
VISA

Stripe Credit Card *

Card

Name on Card

any payments due to Indiana Fat Loss Camp as indicated above. I further authorize my credit card company or bank to make payments(s) to Indiana Fat Loss Camp by the method(s) indicated above and to post it to my account.

Signature

Today's Date *

PAYMENT AUTHORIZATION:

Total *

$ 0.00

STORE CREDIT CARD ON FILE *

ADD CREDIT CARD, EXPIRATION AND CVC NUMBER

Phone