Welcome to Mind Body Blast

Hi, and thank you for applying to the Mind Body Blast One-On-One 6-week Intensive - designed to ramp up your fitness and health in a big way.

I take applications for this particular course because I want to make sure that you and I are a good match, and to make sure you're ready to commit to doing what it takes to claim your health. Simply answer the quick questions below and sign the waiver, and I'll get back to you with how we'll proceed.

Please make note that these questions are for my use only. I will never disclose, or sell, any of your personal information to a third party. All of the questions are optional except the waiver at the bottom of the page.

If you have any questions please don't hesitate to call or e-mail me.
Luci@lucigabel.com or (703)-312-1352

Thanks and I'm looking forward to sharing 6 weeks of adventure and progress with you!

- Luci

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1. I'd love to know what part of this great big world you're coming from. And since we'll be communicating both by e-mail and phone, please let me know the best ways to reach you.

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2. What is your age range?

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3. Have you tried to change your habits before? What kind of changes are you looking to make now?

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4. How would these lifestyle changes help you in your life? What do you want to be different?

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5. How often do you do cardiovascular exercise (movement that makes you breathe faster and deeper) for 30 minutes or more?

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6. How often do you lift weights?

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7. Have you been physically active in the past (i.e.: high school or college athletics, a time when you were very regular at certain types of exercise, etc.)

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8. Have you ever done mind-body exercises (Pilates, Tai-Chi, Yoga, etc), or meditated? Have you ever had physical therapy or operation on your body? Please state which. There will be time for more details in the future.

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9. How would you rate yourself when it comes to making healthy food choices?

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10. Waiver of Liability and Assumption of Risk
(type your name below)

I am aware that fitness and conditioning activities, by their nature, carry with them certain inherent risks that cannot be eliminated regardless of the care the instructor takes to prevent injuries. I also understand that the exercise activities offered by Luci Gabel and affiliates will involve a variety of activities, some may require an exertion of strength and stress to the muscular system, some may challenge balance and agility, and others may involve sustained activities that stress the cardiovascular system. Many activities will involve weights, which have the potential of causing injury. I'm also aware that a nutrition program is included, and I will be in complete control of the foods that I eat at all times. Some foods may be suggested to me, but what I eat will always be at my sole discretion.

The specific risks vary from one activity to another, but in each activity the risks range from minor injuries, bruises, muscle strains and sprains, digestive discomfort, broken bones, joint or back injuries, concussions and heart attacks to the rare occurrence of catastrophic injury including death.

I have read the preceding paragraphs and understand the nature of the activities and the types of injuries that may occur as a result of them. I declare that I am physically sound and unaware of any condition, impairment, disease, infirmity, or other illness that would prevent my participation in an exercise class or use of exercise equipment. I acknowledge the important health safeguard of obtaining my physician’s approval for my participation in an exercise/fitness activity and for changing my dietary habits. I affirm that I have either had a physical examination and received my physician’s permission to participate, or that I have consciously decided to participate in this program without the my physician’s approval. In either event I hereby voluntarily assume all risk for my participation and activities. I understand that I have the option and responsibility at all times to stop performing any activity that I feel I am unable to safely continue.

In consideration of being permitted to participate in this nutrition and exercise program, I hereby release and forever discharge Luci Gabel and Affiliates and any person or entity providing facilities or equipment or in any other way sponsoring, conducting or assisting the program, from any and all claims, causes of action or liability arising from any injury I might sustain. I further agree to defend, indemnify and hold them harmless against any claim of a third party arising from allegedly negligent or wrongful conduct by me during or in connection with the program.

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