PROJECT-ME 2021 REGISTRATION FORM
Welcome to Project ME! We're excited to partner with you in this comprehensive 6 Week challenge! For just $10/day (the cost of 2 White Chocolate Mochas at Starbucks), you'll receive tools, guidance and ProjectME support. Please answer the questions below to the best of your ability, then submit this form so we can assess your current health status, goals, visions, and mindset.This information will be used to customize ProjectME2021 for YOUR lifestyle change needs and goals!

As soon as we receive your completed form we'll send over your first (of three monthly) invoices, as well a detailed email message outlining the complete details and schedules for #ProjectME2021. (FEB 15 - MAR 28) Are you ready? LET'S DO THIS!

Make 2021 YOUR year - Invest in your health. Invest in your mind. Invest in yourself.
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  • GOALS & ACTIVITIES

    Please describe your goal(s), big and small, short and long-term. If you are involved in any regular physical activity/exercise, please describe so we can properly assess your current status, determine customized macros, and help you achieve your nutrition and/or weight loss goals.
  • ACTIVITY DURATION INTENSITY FREQUENCY
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    Sedentary
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    Athlete
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    None
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    Trainer
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    Least Likely
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    Beast
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    10%
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    100%
  • NUTRITION & DIET

    Please detail what you the type of plan you are currently eating, how it's working for you, or what has worked better in the past for you. Also, if you have an eating preference, food allergies, or nutritional concerns please discuss below.
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    I FEAR PLANS
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    100% DEDICATED
  • EMOTIONAL HEALTH

  • HEALTH QUESTIONNAIRE

    Please complete this thoroughly. Even if you do not feel something is significant, your trainer will decide if further explanation is necessary. Thanks in advance for the detail.
  • PICTURE UPLOAD

    During this challenge, especially for the virtual participants, you will need to submit weekly pictures for accountability. After this initial form you will receive a weekly report form you can use to submit, pics, questions, concerns, feelings, etc..

    Picture Requirements:

    Please take pics in a well lit area with a solid light or white background (no busy backgrounds). Same place, same time of day, same day each week, same outfit if possible.

    Guys: Boxers, briefs, etc..

    Ladies: Bikinis, sports bra and tight shorts (or other tight fitting-light colored workout attire).

    *NO full black outfits (lighter shows off features and progress better)

    These pics are meant to show detail of your body to help evaluate progress and losses in specific areas since we will not have access to taking measurements or caliper bodyfat testing (locals in San Diego can get in person measurements-still have to submit photos)
  • LIABILITY WAIVER

    Please Read and Acknowledge *
    Bryan Schuler, MS, NASM-PES,FNS,YES
    Wired Fitness
    Jan Petersen, ACE® Certified Health Coach

    Waiver, Release of Liability, and Assumption of Risk

    I, the undersigned, am employing the services of Bryan Schuler, Wired Fitness and/or Jan Petersen (collectively “Coach” or “Coaches”) so that I can obtain information, guidance, coaching and/or training, as the case may be, related to diet and nutrition (collectively “Nutritional Guidance”) and/or fitness activities, which may include, but are not limited to, aerobic exercises, strength and/or resistance training, and/or stability balance exercises (collectively the “Activity” or the “Activities”). I understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also understand and am aware that any exercise and/or fitness activities involve a risk of injury, which may include abnormal changes in blood pressure, fainting, risk of heart attack or stroke, respiratory distress, joint pain, bone injury, and other serious disability or possible death (collectively, the “Potential Risks and Dangers”), and that I am voluntarily participating in the Activities and the use of equipment and machinery, whether on the premises of Wired Fitness or elsewhere, with the full understanding and appreciation of the Potential Risks and Dangers. I agree to assume and accept the Potential Risks and Dangers associated with any and all Activities and/or Nutritional Guidance in which I participate whether on the premises of Wired Fitness or elsewhere.

    I understand that I will be working with a Certified Personal Trainer and a Certified Health Coach that do not dispense medical advice nor prescribe medical treatment. I also understand that any consultation and/or other services provided by Coaches does not replace the necessary services of a licensed physician and does not constitute a medical service or healthcare treatment.

    I understand that any nutritional and/or physical evaluation or test provided to me is not intended for the diagnosis of disease, but rather is intended to be a guide in developing an appropriate health-supportive program for me, and to monitor my progress in achieving my personal nutritional and/or fitness goals. I also understand that any recommendations made to me will be explained and that I will have the opportunity to ask questions of those involved in my care, and that any exercise and/or Activities performed, whether on the premises of Wired Fitness or elsewhere, will be entirely at my own risk.

    I understand that the potential benefit of the Nutritional Guidance and/or Activities may include decreased body fat, improved cholesterol levels, improved blood pressure, increased muscle strength and endurance, decreased risk of heart disease, and improved psychological function. I also understand that the benefits experienced may vary and directly relate, among other factors, to prescribed intensity, duration, frequency, progression, and types of Activity, as well as my dedication thereto.

    I have read the above information and understand the Potential Risks and Dangers of working with Coaches and the use of premises and equipment, and acknowledge that as a condition to engaging services of Coaches, I agree (i) to ASSUME ANY AND ALL POTENTIAL RISKS AND DANGERS REGARDLESS OF SEVERITY OR DEATH, (ii) to WAIVE, RELEASE, AND NOT SUE, MAKE ANY CLAIMS OR FILE ANY ACTIONS against Coaches, the ProjectME2021 90-Day Challenge, its owners, affiliates, officers, agents, employees, volunteers, contractors, successors and assigns (collectively, the “Indemnified Parties”, and individually, the “Indemnified Party”), that are based on, arise, or result from, in whole or part, participation in the Nutritional Guidance and/or any Activity whether on the premises of Wired Fitness or elsewhere, and (iii) to INDEMNIFY, DEFEND, AND HOLD THE INDEMNIFIED PARTIES HARMLESS from any and all claims, demands, actions, causes of action, losses or liabilities whatsoever arising from or related to participation in the Nutritional Guidance and/or any Activity whether on the premises of Wired Fitness or elsewhere, and any loss, damage, or injury or death, that I may sustain or cause to be sustained to others or their property. I agree to pay all costs, including reasonable attorney’s fees and disbursements, incurred by any Indemnified Party in defending an investigation, claim or suit brought by or on my behalf. I authorize Coaches and/or its authorized personnel to call for medical care, treatment, and/or procedures, or to transport me to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed.

    I authorize Coaches and/or authorized personnel to take and use photographs, video recordings, or movies of me that are taken during an Activity or Nutritional Guidance consultation. I understand that Coaches must obtain my prior written consent to use and sublicense such material for any purpose in promoting Coaches.

    I agree that ALL claims arising from or related to any Nutritional Guidance, Activity, or use of the premises and equipment of Wired Fitness during the ProjectME2021 90-Day Challenge, including for injury to person or property and/or death shall be GOVERNED BY CALIFORNIA LAW, without regard to choice of law or conflict of law principles, and that EXCLUSIVE JURISDICTION shall be in the District Court residing where the alleged incident occurred or in Federal Court for the District of Southern California. I VOLUNTARILY AND IRREVOCABLY WAIVE ANY OBJECTION TO SUCH LAW AND JURISDICTION.

    I acknowledge that this Agreement shall be binding to the fullest extent permitted by law. If any provision of this Agreement is found to be unenforceable, the unaffected terms shall be enforceable and remain in full force and effect. This Agreement shall be binding upon my assignees, subrogors, distributors, heirs, next of kin, executors, and personal representatives.

    I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS AGREEMENT IN ITS ENTIRETY, THAT I FULLY UNDERSTAND ITS CONTENTS, AND THAT I AM SIGNING IT WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE. BY SIGNING THIS DOCUMENT I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18, OR AM THE PARENT OR LEGAL GUARDIAN OF A MINOR UNDER THE AGE OF 18 FOR WHOM I AM ENTITLED TO SIGN ON THEIR BEHALF AND THAT SAID MINOR WILL BE BOUND BY ALL OF THE TERMS UNDER THIS AGREEMENT.

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