• Client Details

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  • Pre-Diabetes Risk Test

  • Demographic Information:

  • Eligibility Requirements

    You must be at least 18 years or older (if under 18, parent must participate with you).

  • Employment Information

  • PLEASE READ THE FOLLOWING DISCLAIMER


    1. I acknowledge that all the information provided on this application is true and accurate and any false or misleading information submitted herein is grounds for my immediate elimination from consideration. This application and any other material submitted by me, including pictures, becomes property of B2H&W and Associates, and shall not be returned whether or not I am selected as a participant. I also hereby understand that even if I meet the eligibility requirements, B2H&W and Associates has no obligation to interview me, and/or select me as a participant. I further understand that by submitting this application it no way guarantees selection, as it is merely for the purpose of evaluating potential participants.

    2. I, for myself, my heirs and assigns, do hereby waive, release, and forever discharge B2H&W and Associates, their officers, agents, employers, representatives, investors and executors from injuries or damages resulting from my participation in their program.  I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability, now or in the future, for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf, or in any way arising out of or connected with my participation in any activities of B2H&W and Associates.

    3. I understand and am aware that strength, flexibility, and aerobic exercise are a potentially hazardous activity.  I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities.  I hereby agree to expressly assume and accept all risks of injury or death associated with any program of B2H&W and Associates.

    4. I understand that any photographs taken during these classes may be used on promotional materials, printed or electronic.

    By signing below, you acknowledge that you have read the disclaimer above and agree with its entire contents and that all the information provided on this application is true and accurate, and any false or misleading information submitted is grounds for my immediate elimination from consideration.

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    26 Week Online Program Bridge 2 Health and Wellness 26 Week Online Program teaching how to live a healthy lifestyle that helps you loss weight, improve attitude and decrease the need for medications.
    $ 50.00
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