Participants Waiver Form

Balanced Habits LIFE Participant Health Acknowledgement, Waiver & Release Form

Welcome to the Balanced Habits LIFE! Your health is important to us. Please review our health acknowledgement to ensure you are ready to get started. Before beginning the LIFE Program, and as consideration for being enrolled in the program, you acknowledge that:
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- you do not require a special diet (vegan, kosher, or halal) or, if you usually do follow a special diet, you have discussed this special dietary need with your Balanced Habits LIFE Advisor and discussed whether the Balanced Habits LIFE is right for you, and you still want to enroll in the Balanced Habits LIFE Program;
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- you are not allergic to any foods or, if you are allergic to certain foods, you have discussed this food allergy with your Balanced Habits LIFE Advisor and discussed whether the Balanced Habits LIFE is right for you, and you still want to enroll in the Balanced Habits LIFE Program;
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- you do not have celiac disease;
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- you are not being treated with hemodialysis;
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- if you are diabetic, you have advised your Balanced Habits LIFE Advisor of your condition and discussed whether the Balanced Habits LIFE is right for you, and you still want to enroll in the Balanced Habits LIFE Program;
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- you have not been advised by a doctor to limit your physical activity or, if you have been so limited by your doctor’s recommendation, you have provided a copy of that order to your Balanced Habits LIFE Advisor and discussed whether the Balanced Habits LIFE is right for you, and you still want to enroll in the Balanced Habits LIFE Program;
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- you do not have a medical condition that would prevent you from participating in the Balanced Habits LIFE Program;
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- you understand that, while your Balanced Habits LIFE Advisor may suggest that you eat certain foods, he/she may not be either a certified Nutritionist or a certified Dietitian and, therefore, may not be qualified to prescribe that you eat certain foods;
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- you are responsible for your own health and will inform your doctor and your Balanced Habits LIFE Advisor if you experience any negative changes in your health while you are participating in the Balanced Habits LIFE Program and using the Balanced Habits LIFE tools, content or products.
Accordingly you hereby waive and release TakeDown LifeStyle, LLC, and its affiliates, employees, agents, representatives, successors, or assigns of any and all liability, claims or causes of action related to these health acknowledgements and your participation in the Balanced Habits LIFE Program.
Date*
Date Format: MM slash DD slash YYYY
Name*
Phone
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