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6 Week Weight Loss Challenge Application Form
6 Week Weight Loss Challenge Application Form
This questionnaire is to screen whether you qualify for the 6-weeks virtual weight loss challenge. Please take 1 minute to fill out this application form as accurately as possible.
Clone of 6 Week Weight Loss Challenge Application Form
  • 1
    How do we address you?
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  • 2
    Tell us your birth date.
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    Pick a Date
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  • 3
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  • 5
    • Friend
    • Current Client
    • Social Media
    • Advertisement
    • Google Search
    • Website
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  • 6
    In kilograms (E.g. 95.0)
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    In meters (E.g. 1.80)
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  • 8
    Please note this is your LONG TERM goal not what you want to lose in the next 6 weeks
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  • 9
    Recordings available if you miss some Live sessions.
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  • 10
    A customized meal plan and easy recipes will be given to you.
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    E.g. Knee pain, back pain, shoulder issues
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  • 18

    Declaration

    The health and medical information provided is true and accurate and to the best of my knowledge. Whilst I realise that I will be provided with an exercise and weight loss program that is safe and effective, I am choosing to participate at my own risk.

    I declare that I am not pregnant and do not plan on becoming pregnant during the course of the challenge. If my health, or any other condition changes that would impact any of the above questions, I will advise my trainer and have this updated immediately.

    By signing this form, I agree to release all forms of liability and waiving any rights of mine or that of my successors to bring legal action or assert a claim against KD Trainer or that of their employees, agents or contractors.

    Disclaimer

    The information provided to me during the 6 week challenge will be useful information on weight loss, healthy eating and exercise and is not intended as a substitute for advice from a medical practitioner or health care provider. Before starting any weight loss program or exercise you should gain advice or guidance on any health conditions/illnesses. I understand that everyone will lose weight at different rates and so I may lose weight slower or faster than others I have seen.

    Other Terms

    I understand that all information provided to me will be kept confidential and not shared with others.

    Upon signing this application I understand that I am liable for all the costs associated with this challenge, and that no refunds will be available except for three conditions:


    1. Doctors letter was received advising that you were unable to continue due to a medical condition

    2. No weight loss achieved at the end of the program after complying to all our training and recommendations

    3. Failure to attend 80% of the sessions provided by our team

    at which point I would be entitled to a pro-rated refund of your remaining program.

    I have read the above statements and agree to follow the program exactly as outlined by my trainers and dietitians. I have read this application form in its entirety including the declaration, disclaimer and other terms sections and understand the information that has been provided to me.

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    Pick a Date
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  • 21
    Please sign your waiver to complete the enrolment.
    Clear
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