1. PURPOSE OF THE PROGRAM
The Glow State Reset is a guided wellness program that includes nutritional guidance, detox support, juice fasting (or an alternative reset), emotional release tools, and group support.This program is not a medical treatment and does not replace medical advice, diagnosis, or care from a qualified health professional.
2. DISCLOSURE OF MEDICAL CONDITIONS & MEDICATIONS
I understand that I must disclose any relevant:
Medical conditions
Diagnoses
Injuries
Food allergies or intolerances
Medications or supplements
Mental health considerations
I confirm that I have provided this information honestly and in full to the program facilitator, Hannah Barnes, and that this information will be kept confidential (space at end of form to provide details)
3. ACKNOWLEDGEMENT OF RISKS
I understand that juice fasting, detox protocols, and dietary resets may involve physical, emotional, and mental challenges, including but not limited to:
Headaches or dizziness
Fatigue or low energy
Nausea or digestive discomfort
Blood sugar fluctuations
Emotional release or mood changes
Temporary weakness or light-headedness
Detox symptoms such as skin breakouts or changes in bowel movements
I acknowledge that these reactions can occur and that my participation is voluntary.
4. PERSONAL RESPONSIBILITY
I understand and agree that:
I am responsible for listening to my body and caring for my wellbeing.
I am responsible for seeking medical advice if I have concerns at any time.
I am responsible for deciding whether this program is appropriate for me.
I am responsible for stopping the program or modifying it if I feel unwell or unsafe.
I will notify Hannah if any health concerns arise during the program.
I understand that the facilitator offers general guidance and support only and is not acting as my medical provider.
5. NO MEDICAL CLAIMS
I understand that:
The program does not diagnose, treat, or cure medical conditions.
No outcomes are guaranteed, including weight loss, symptom reduction, or healing results.
All health decisions I make are ultimately my own.
6. RELEASE OF LIABILITY
By entering my name and date below, I acknowledge that:
I am participating voluntarily and at my own risk.
I release and hold harmless Hannah Barnes, and all associated facilitators from any liability, claims, damages, or injuries that may arise from my participation.
I assume full responsibility for my physical, emotional, and mental wellbeing throughout the program.
7. CONFIRMATION OF UNDERSTANDING
I confirm that:
I have read and understood this entire disclaimer and informed consent.
I have had the opportunity to ask questions.
I agree to all terms stated above.
I am competent and legally able to provide consent.
Who Should Not Participate in Juice Fasting
Fasting is not suitable for everyone. Please do not participate if you:
Are pregnant or breastfeeding (speak to me about an alternative, safe cleanse)
Have a history of eating disorders
Are severely underweight
Have Type 1 Diabetes
Are under 18 years of age
Your Responsibility
By participating, you assume full responsibility for your own health and well-being during the juice fast. The information provided during this program is for educational and informational purposes only and should not be construed as medical advice.
Consultation with Healthcare Provider
I strongly advise consulting your doctor or healthcare professional before beginning any juice fast or wellness program, especially if you have any underlying health concerns.
By entering your details below, you agree that you have read and understood this disclaimer, and you accept full responsibility for your participation.
