Health Declaration

Your health and safety are important to us. Please complete this form 24 hours before officially starting Day 1 to ensure you receive all necessary guidance and support. Submissions are valid up to 24 hours prior to the activity.

First name

Last name

I confirm that I am not pregnant.

Are you currently taking any medications that may be affected by fasting?

Yes

Do you have any pre-existing medical conditions (e.g., diabetes, heart disease, low blood pressure, eating disorders, etc.)?

Date

Initials

I acknowledge that I am voluntarily participating in the 21-Day Fasting Challenge. I understand that fasting may not be suitable for everyone and that I should consult a healthcare professional before making any significant changes to my diet or lifestyle. I take full responsibility for my health and well-being during this challenge.

I confirm that the information given in this form is true

Thanks for submitting!