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Membership Form

You will be redirected to our Health Evaluation Form after completing this form. The Health Eval form is required to complete your membership registration.

Garza Membership Sign Up and Liability Form

Personal Information

First Name *

Last Name *

Date of Birth *

Phone Number *

E-mail *

Address *

City *

State *

Zip Code *

Facebook Name

Membership Options

NOTE: All Blue Mat Memberships include Live Stream access.

Secondary Member Contact Info

Relationship to Primary Member *

Secondary Member First Name *

Secondary Member Last Name *

Secondary Member Date of Birth *

Secondary Member Phone Number *

Secondary Member Email Address *

Secondary Member Address *

Secondary Member City *

Secondary Member State *

Secondary Member Zip Code *

Secondary Member Facebook Name *

Digital Signature Acknowledgement on Liabilities

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.

Interviews, Photos, and Video Release

I hereby grant Garza's Fat Loss Camps/SHK Consulting LLC/TLC Fitness LLC permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled Garza's Fat Loss Camp in perpetuity, and for other use by Garza's Fat Loss camp. I will make no monetary or other claim against Garza's Fat Loss Camp/SHK Consulting LLC/TLC Fitness LLC for the use of the photograph(s)/video.

Secondary Acknowledgment Signature *

Payment and Authorization Info

AGREEMENT

I authorize TLC Fitness, Inc/SHK Consulting LLC to charge my credit or debit card or draft via EFT from the bank account indicated any and all payments due to TLC Fitness, Inc/SHK Consulting LLC as indicated above. I further authorize my credit card company or bank to make payment(s) to TLC Fitness, Inc/SHK Consulting LLC by the method(s) indicated and post it to my account.

Credit or Debit Card Info

Credit Card Number *

Credit Card Type *

American Express Discover Mastercard Visa

Expiration Date *

CVV Code *

EFT Bank Draft Info

Name on Account *

Routing Number *

Account Number *

There is a $30 fee for every returned payment.

Payment Authorization Signature

Signature *

Date of Signature *

Acknowledgements

Automatic Month to Month

The six (6) or twelve (12) consecutive month Membership commitment (chosen above) will automatically go month to month and be considered active after is has been completed, until cancelled as described in the Cancellation Policy.

CANCELLATION POLICY AND EARLY CANCELLATION PENALTY

Garza’s Fat Loss Camp member MUST give a 30-day notice of cancellation by going to submitting the Garza’s Membership Cancellation form. Members are responsible for all membership fees and charges to their account through that date. This form must be submitted at least 30 BUSINESS days prior to your last intended debit to ensure proper processing. (Please note: Even if you notify your instructor of your intent to cancel, you are still required to submit a completed “Cancellation Form”. If for any reason, you cancel before completing the agreed-upon 6-month or 12-month agreement, a $65.00 fee will be due for every debit date not yet paid, after receiving the Cancellation Form. This total amount will be due and debited immediately. If at any time your account is not paid per this contract and it is turned over to our collections department there will be a $250 collection fee charged to your account.

GARZA'S FAT LOSS CAMP MEMBER/PARTICIPANT ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND RELEASE FROM LIABILITY OF GARZA'S FAT LOSS CAMP/SHK CONSULTING LLC/TLC FITNESS LLC.

PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVE THE INHERENT RISK OF PHYSICAL INJURY OR OTHER DAMAGE, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES. GARZA'S FAT LOSS CAMP MEMBER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO,INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A GARZA'S FAT LOSS CAMP MEMBER, SLIP AND FALL BY GARZA'S FAT LOSS CAMP MEMBER, OR AN UNKNOWN HEALTH PROBLEM OF GARZA'S FAT LOSS CAMP MEMBER. GARZA'S FAT LOSS CAMP MEMBER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES. GARZA'S FAT LOSS CAMP MEMBER AFFIRMS THAT GARZA'S FAT LOSS CAMP MEMBER/PARTICIPANT IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES. GARZA'S FAT LOSS CAMP MEMBER ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, GARZA'S FAT LOSS CAMP MEMBER AGREES THAT IT IS THE RESPONSIBILITY OF GARZA'S FAT LOSS CAMP MEMBER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE,REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF MEMBER/PARTICIPANT TO TAKE PART IN GARZA'S FAT LOSS CAMP ACTIVITIES. BY AGREEING TO THIS AGREEMENT. GARZA'S FAT LOSS CAMP MEMBER/PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. GARZA'S FAT LOSS CAMP MEMBER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.

Interviews, photos and video release

I hereby grant Garza's Fat Loss Camp TLC Fitness, Inc/SHK Consulting LLC permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Garza's Fat Loss Camp in perpetuity, and for other use by Garza's Fat Loss camp. I will make no monetary or other claim against Garza's Fat Loss Camp/ TLC Fitness, Inc/SHK Consulting LLC for the use of the photograph(s)/video.

Acknowledgement Signature *

Acknowledgement Date *

Digital Signature Acknowledgement on Liabilities

TravisGarza.com

PO Box 414
Edmond, OK 73083

405-820-3813

info@travisgarza.com

ALL I ASK MY CLIENTS TO DO IS SHOW UP AND FOLLOW MY INSTRUCTIONS.

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