#WeGut2Know National Health Challenge Sign-Up Form
Deadline: Midnight February 17th 2024
Date of Birth
Prefer not to say
Mobile Contact Number
Please enter a valid phone number.
Social media handles
Please add Twitter, IG or FB.
Health and Lifestyle Information
Current Gut Health Status: Briefly describe any gut-related issues or symptoms you are currently experiencing. List any diagnosed conditions related to gut health (e.g., IBS, IBD, acid reflux).
Some of the services can be covered by your insurance provider. (If you do not have insurance this does not disqualify you from entering.) Do you have health insurance?
If yes, please select which group your insurance provider falls into.
GEHI or Argus
BF&M or CG
Dietary Habits: Describe your typical daily diet. Note any known food allergies or intolerances.
Lifestyle and Exercise: Outline your current exercise routine, if any. Describe your typical daily activities and lifestyle.
Are you medically & physically able to participate in this challenge?
Commitment and Motivation
Why do you want to participate in the #WeGut2Know National Health Challenge?Explain your motivation and what you hope to achieve.
Are you willing to make dietary and lifestyle changes as recommended by healthcare professionals?
Are you comfortable documenting and sharing your health journey for educational and promotional purposes?
Consent and Acknowledgments
Do you understand and agree to the terms and conditions of the challenge?
Do you consent to the use of your data and experiences for educational and promotional activities related to the challenge?
Is there anything else you would like to share that might be relevant to your application?
We will have 2 in-person events that all chosen contestants need to attend. These are from 6-8 pm on both evenings of February 19th and 20th. Can you make both days in-person?
Yes, I can make both evenings
Yes I can make February 19th but not 20th.
I cannot make February 19th but can make the 20th.
I cannot make either of those dates.
Please upload a picture we can use for our promotional material if you are chosen.
Drag and drop files here
Choose a file
Please only upload a JPG, JPEG, or PNG file.
Please ensure all fields are completed accurately. Incomplete applications may not be considered. Your privacy and the confidentiality of your information are of utmost importance to us.
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