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2018 Total Wellness Cleanse Registration

1.  I, the undersigned employee, desire to participate in the “Total Wellness Cleanse” nutrition challenge (the “Voluntary Activity”). In consideration for the opportunity to participate in the Voluntary Activity, I, on behalf of myself, my heir(s) and personal representative(s), DO HEREBY WAIVE ANY AND ALL CLAIMS FOR DAMAGES AGAINST my employer, DIRECTORS, EMPLOYEES, REPRESENTATIVES, AGENTS AND SUBCONTRACTORS THAT MAY DIRECTLY OR INDIRECTLY ARISE FROM, OUT OF, OR IN CONNECTION WITH, MY PARTICIPATION IN THE VOLUNTARY ACTIVITY.
I acknowledge that I have been encouraged by my employer to consult with my personal physician before starting the Voluntary Activity to ensure that it is safe for me to do so. I further acknowledge and agree that any changes in my diet or exercise, or the use of any dietary supplements (including, but not limited to, weight reduction supplements and appetite suppressants), are my sole responsibility and at my sole discretion, and are not made or used at the encouragement, direction or coercion of the Employer.
*This question is required.