Wellness Community for Women by Deju

First and Last Name*

Phone Number*

Email address*

example@example.com

Do you have any medical condition that could hinder your nutrition/weight loss journey?*

Type YES or NO

If yes, we encourage you to consult with your healthcare provider before starting any weight loss journey

Have you had a bloodwork completed within the last 6 months*

Type YES or NO

Have you tried any diet in the past or are you currently using one?*

Type YES or NO then specify

Have you fasted before and for how many hours?*

Type YES or NO then specify

Do you smoke?*

Type YES or NO

Do you consume alcohol?*

Type YES or NO

Please state your ideal Breakfast, Lunch, and Supper/dinner*

Multiple answers are welcome

What is/are your staple food?*

(Foods that you cannot do without) Multiple answers are welcome

What are your goals for joining the wellness community for women's fitness and nutrition group? E.g., Lose weight, build muscle, make healthy choices. Please be specific*

Please be specific

What are the challenges that could hinder you from attaining your goals? E.g., time, cost of food, family, work schedule, cravings, existing lifestyle, hate cooking, etc.*

Please be specific

Would you like to be paired with a group member (Accountability partner)? *

(Optional) Type YES or NO

At my risk, I consent to participate in the Wellness Community for Women group coaching by Engage Wellness (EW). The coach and Engage Wellness will not be responsible for any injuries incurred before, during, or after my membership. I will ensure safety in my space during personal or group fitness.

I consent to be respectful in the community and keep all other member's information confidential. Also, EW can share my anonymous or named testimonials with their clients.

Sign your FULL NAME here to give consent*

Please be specific

Date*

Date

Almost done ...

Thank you for filling out the form! You have made a valuable decision for yourself today. I am Deju, and I will be your coach.

This is a 5-week virtual group coaching (Orientation and invitation into the WHATSAPP GROUP will be done one week before coaching commences officially and you will be removed from the WhatsApp group after post-coaching evaluations).

Once the form is completed, a subscription payment of $150 (tax included) is payable via cheque addressed to Engage Wellness, e-transfer or PayPal to engagebydeju@gmail.com.

What to expect as a member of our group fitness/nutrition coaching:

- This comprehensive coaching program details mindset reset, kitchen reset, weekly fitness plan, nutrition ideas, detox/bowel movement principles, intermittent fasting plan, motivations, gratitude/self-care, etc.

- A guided fitness and nutrition challenges

- A one-week water challenge + other challenges

- Kitchen reset (The instructions will be given when admitted into the group)

- Weekly 30-minute virtual or recorded fitness sessions

- A paired accountability partner (Optional)

- TWO 30-Minutes wellness consultations with Deju (only valid during the coaching period - know your body type and receive customized recommendations for your macronutrient ratio)

- A 20% discount on Engage Wellness programs and one-on-one coaching during your membership.

THANK YOU, AGAIN, FOR TAKING YOUR HEALTH JOURNEY SERIOUSLY! LET'S WIN TOGETHER, WELL WOMAN. YOU ARE WORTHY OF A WELL LIFE.

YOU BELONG!

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