Wellness Foundation
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Programs

Wellness Challenge Reservation

[New introductory content needed here.] By enrolling now your place will be reserved for our upcoming Challenge. You will not be fully registered until all paperwork and lab results are completed and received by the Wellness Foundation. Once we have received your completed registration we will send our Wellness Challenge Jumpstart Guide which includes everything you need to be prepared to start the Challenge, including a Week One Meal Plan and shopping list.

Cost: $250 per person. This in non-refundable.

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Wellness Challenge Location

Choose a Location:

Wellness Challenge Participant Information

Salutation:
* First Name:
Middle Initial:
* Last Name:
* Address:
* City:
* State:
* Zip:
* Home Phone:
Office Phone:
Cell Phone:
* Email:

Billing Information

Same as above
* First Name on Card:
* Last Name on Card:
* Billing Address:
* Billing City:
* Billing State:
* Billing Zip:
* Billing Phone:
* Card Type:
* Card Number:
* Security Code:
(last 3 digits on back of Visa/MC/Discover, 4 digits on front of AmEx)
* Expiration Month:
* Expiration Year:

INTENTION, DISCLOSURE, AND LIABILITY RELEASE

INTENTION:
It is the intention of Wellness Foundation (the Foundation) and its directors, officers, employees, and volunteers to provide information in regard to nutritional excellence, stress management, fitness, attitude, and the power of thoughts and words. The role of the Foundation will be as a facilitator. It is expected that people receiving information from the Foundation and/or participating in any of its meetings will be responsible for their own health and will be under the care of a medical professional for that purpose.

DISCLOSURE:
Douglas D. Mercer, founder and president of the Foundation has no professional training, degrees or certificates in regard to wellness. All of his knowledge on the subject has been gained through personal experience by attending wellness institutes, studying professional literature, speaking and consulting with medical professionals, learning through experiences of family, friends, and acquaintances, and learning through changing his own habits.

LIABILITY RELEASE:
The undersigned fully understands that he or she is responsible for any changes in lifestyle habits that he or she may choose to make. The undersigned also agrees to indemnify and hold Douglas D. Mercer, the Foundation, and/or its directors, officer, employees, or volunteers harmless from all claims, judgments, expenses and costs, including but not limited to attorney's fees incurred in connection with any claims brought as a result of his or her involvement in the Foundation and/or participation in any of its meetings or any of the Foundation's programs including the Wellness Challenge and subsequent support including, but not limited to, any claim of medical complications, allergic reaction, or failure to achieve his or her desired health benefit.

Wellness Foundation programs and classes are designed to teach skills to achieve and maintain a healthy weight and to improve health. The program is not intended to be instructional for medical diagnosis or treatment. Please consult with your physician before beginning any of the Foundation's programs or any other weight loss program. If there is a change in your medical condition as a result of your participation in any of the Foundation's programs, you should immediately notify your physician.


  I agree to the Intention, Disclosure, and Liability Release