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Health Evaluation Form

Health Evaluation Form

Personal Info
Street, City, State, Zip
(Emergency contact relationship to you)
Health History Questionnaire
What Works?

I understand that by following the eating program/workout program to the best of my ability will yield greater results. I also understand that by not drinking any alcoholic drinks except for one day per week (cheat day) will yield results at an accelerated rate. I agree to hold harmless Travis Garza/TLC Fitness, Inc./ SHK Consulting LLC and all of his employees or agents free from any and all injuries, losses, damages, and liability occurring from my participation in the activity for which I have enrolled. I also agree to be photographed/videotaped and release the use of the photographs/videos for publicity in Travis Garza’s ‘Fat Loss Camps’, TLC Fitness, Inc.’s, and SHK Consulting LLC’s publications and other marketing tools.

(enter your full name)
(Parent/Guardian's full name)

By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

PO Box 414
Edmond, OK 73083



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