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I'm so happy you decided to make the decision to put YOU first!

Yay! You made it!!

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If you’re looking to gain your confidence back, fit into those clothes that are hiding in your closet, finally get results,  and find a community of people who are on a mission of doing the same…You are in the right place! 

 This group will be a great resource to you; the community and support within our group is unmatched! Before you become a part of our community, please do take a moment to fill out this brief intake form below so I can better help you!

    Once completed, you will be sent to continue on with the next steps to join our amazing community!

Birthday
Month
Day
Year
Multi-line address
How did you find me?
Shirt size - Unisex
Do you smoke?
Yes
No
Do you drink?
Yes
No
Are you Pregnant or Breastfeeding?
Yes
No
What are your fitness goals?
To what level of accountability do you expect me to hold you to?
1- I got this - just give me a little feedback
2
3
4
5
6
7
8
9
10- Make me cry - Scream and beg for mercy….
Are you currently tracking your nutrition?
Yes
No

Waiver & Release of Liability

IN CONSIDERATION OF the risk of injury that exists while participating in STRENGTH TRAINING/ PERSONAL TRAINING (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge Healthy Life., their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, ORFROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Healthy Life to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the Healthy Life official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Healthy Life AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Healthy Life LLC. FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Healthy Life its agents, and employees.

I agree that this Release shall be governed for all purposes by Arkansas law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement

between two parties of equal bargaining strength. Both Participant, and Healthy Life agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.


​By using the e-sign feature below, each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Photography Release Form

I , hereby grant and authorize Healthy Life the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me by Healthy Life to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing.

I understand and agree that these materials shall become the property of Healthy Life and will not be returned.

I hereby hold harmless, and release Healthy Life from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

​By using the e-sign feature below, each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Electronic Signature Agreement

1. Consent to Electronic Transactions

By signing this Agreement electronically, you agree that your electronic signature (e-signature) carries the same legal effect as a handwritten signature and is legally binding under the Electronic Signatures in Global and National Commerce Act (E-SIGN Act) and any applicable state laws.

2. Scope of Agreement

You acknowledge and agree that:

  • Any document you sign electronically shall be considered as if you had signed a physical copy.

  • Your electronic signature is valid for all agreements, forms, and communications related to the transaction or business engagement.

  • You have the necessary hardware and software to receive, review, and retain electronic documents.

3. Withdrawal of Consent

You may withdraw your consent to e-signatures by providing written notice. However, withdrawing consent may result in delays or limitations in service. Any withdrawal will not affect the validity of prior electronic transactions.

4. Accuracy and Security

You are responsible for ensuring that your electronic signature is accurate and secure. If you suspect unauthorized use, you must notify us immediately.

5. Acknowledgment and Acceptance

By proceeding with an electronic signature, you confirm that you:

  • Have read and understand this E-Sign Agreement.

  • Agree to use electronic signatures for all applicable transactions.

  • Understand that your electronic signature is legally binding.


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HEATHER LANDERS

OWNER, HEALTHY LIFE

HEALTH & WELLNESS COACH

ATC/L (Certified Athletic Trainer)

NASM - CPT (Certified Personal Trainer)

Precision Nutrition - CNC (Certified Nutrition Coach)

1ST Phorm Trainer

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