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21-Day Wellness Challenge Form

Relationship Status
Single
Dating
Married
Divorced
Other
Do you have any health conditions or dietary restrictions that we should be aware of?

Goals for the Wellness Challenge:

Do you have a support system in place to help you stay motivated?

Commitment and Accountability:

Are you ready to commit to 21 days of focused wellness activities?
How will you hold yourself accountable to your goals during this challenge? (Choose all that apply

Evaluation:

How do you plan to track your progress throughout the 21 days? (Choose all that apply)

Terms and Conditions:


  1. Non-Medical Nature of the Challenge: I understand that the Organizers/Coaches are not licensed medical, psychological, or counseling professionals and are not diagnosing, treating, or prescribing any medical or psychological conditions. The Challenge is for personal development purposes only and should not be used as a substitute for professional advice.

  2. Confidentiality Statement: All information shared during this relationship challenge will be kept strictly confidential. This includes any personal details, discussions, and materials provided, except as required by law or with your explicit consent.

  3. Personal Responsibility: I recognize that participation in the Challenge is entirely voluntary. I am fully responsible for my own actions, decisions, and well-being throughout the duration of the Challenge. If I have any health concerns or require medical, psychological, or relationship-related advice, I will consult with a qualified professional before participating.

  4. Assumption of Risk: I understand that participating in the Challenge may involve emotional or physical difficulties, and I assume all risks associated with my participation. I acknowledge that my involvement in the Challenge is at my own risk and discretion.

  5. Waiver of Liability: In consideration of my voluntary participation in the Challenge, I hereby release, discharge, and hold harmless the Organizers, their employees, agents, representatives, and affiliates from any and all liability, claims, demands, or causes of action that may arise from my participation, including but not limited to any injury, emotional distress, or other harm that may result.

  6. No Guarantees: I understand that the Organizers do not guarantee any specific outcomes or results from my participation in the Challenge. Any benefits derived from the Challenge are dependent on my personal engagement and efforts.

  7. Termination of Program: The coach reserves the right to terminate the program at any time, at their sole discretion, without prior notice. This decision may be based on factors including, but not limited to, participant behavior, failure to adhere to program guidelines, or other circumstances that the coach deems detrimental to the integrity or success of the program. In the event of such termination, the coach will not be obligated to provide any further services, and no refunds or reimbursements will be provided.

  8. Agreement to Terms: By participating in the Challenge, I agree to the terms and conditions set forth in this waiver and release of liability. I confirm that I have read, understood, and consent to the terms of this document.

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