By submitting this application you agree with the following: I (the applicant) promise that I am providing an honest, comprehensive and complete history of all pertinent health, supplementary and dietary information.  I understand that not disclosing relevant information could lead to less optimal results and further risk my own health.  

 

Please also understand that Break The Cycle LLC / Katie Wojcicki is not a licensed dietitian or nutritional specialist. You (applicant) fully understand that Break The Cycle is a consulting firm, not a registered dietitian or medical advisor in any way. All recommendations given are undertaken at your own risk. All information you obtain will be directly from Katie Wojcicki's own experiences.  It is of best interest for anyone looking to start a fitness program to consult a physician before doing so, including a comprehensive physical performed by a licensed physician.

 

You (applicant) fully understand that you (applicant) may injure yourself as a result of participation in a program, and hereby release Kathryn Wojcicki / Break The Cycle from any liability now or in the future for any injury, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused , occurring during or after my participation in the fitness program offered.

 

By submitting this application, you state that in consideration of your participation in Break The Cycle's programming, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless, Break The Cycle LLC and Katie Wojcicki from any claims arising from your fitness program.

 

By submitting this application, you affirm that you have read, have been honest with all information provided to Break The Cycle, and also fully understand the above information. You have been given the opportunity to present questions in all related matters.

 

PLEASE MAINTAIN A COPY OF THIS DOCUMENT FOR YOUR OWN RECORDS