Sugga Mamas Diabetes Prevention and Management OCTOBER 2022 BOOT CAMP

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10/1, 10/8, 10/15, and 10/22- Please register for this free program. We will send you the zoom link

Diabetes/ Prediabetes Boot Camp-Invite a Friend or Family Member

First and Last Name *

Email address *

Gender *

Female

Male

Required

Mailing Address ( No. & Street) *

City & State *

Zip Code *

Phone number

Have you ever been told by a doctor that you have diabetes? *

Yes

Have you ever been told by a doctor that you have prediabetes? *

Yes

This is my first time attending the Sugga Mamas Virtual Boot Camp *

Yes

Group Classes Confidentiality Agreement Group Classes may involve the voluntary disclosure of personal or health information that information is private and confidential. I have read and agree to the following statements: I agree to participate in the group class. I agree to respect the confidentiality of the personal or health information shared by other group class participants and will not share that information with other parties .By logging on to the zoom meeting and remaining logged in, I agree to the terms and conditions stated above. *

I agree

Sugga Mamas Diabetes Prevention and Management as part of the Diabetes Boot Camp Experience, offers an optional virtual low impact workout. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be eliminated. I understand that it is my responsibility to listen to my body. If I experience any pain or discomfort I will adjust my posture or stop the workout. I am aware of the physical risks involved with exercise and understand it is my personal responsibility to consult with my physician regarding my participation. I assume responsibility for any risk or injury I may sustain as a result of my participation. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Sugga Mamas Diabetes Prevention and Management I have read the above release and waiver of liability and understand its contents. By logging on to the zoom meeting and remaining logged in, I agree to the terms and conditions stated above. *

I agree

I would like you to send information to my family member or friend- First Name and Last Name

Submit

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