Below are the Participation Guidelines and Voluntary Participation Agreement to review.  You can download these documents as well as the application.

 participation-guidelines

voluntary-participation-agreement

weight-away-tampa-bay-program-application1 - pdf file

weight-away-tampa-bay-program-application2 - word file

Participation Guidelines

• The candidates must be individuals that medically need weight loss and professional supervision but could not normally afford to receive these services
• Candidates will be required to undergo a background screening
• Candidates will receive counseling regarding dietary changes, as well as many other weight loss tools that will help them to achieve success
• Therapeutic hypnosis as a means to empower the candidates by including positive messages about healthy eating, self image, and by addressing any food addictions or personal issues will be used
• Candidates must commit to weekly visits at one of Dr. Lara’s three centers, to track progress and discuss any issues
• Candidates are committing to monthly group hypnosis sessions and 3 individual sessions throughout the process with Debbie Lane.  They are also committing to listen to the audios of their session that are provided. 
• Candidates must be 18 years or older and selected candidates must execute a release to allow their stories and photos to be shared with the public.
• Candidates can nominate themselves, or be nominated by family or friends
• Application is available only at www.weightawaytampabay.com.

Completed applications can be emailed to jbrunson@cesarlaramd.com, faxed to 727-446-7423, or mailed to Weight Away Tampa Bay, 1217 Ewing Ave, Clearwater, FL 33756.

Voluntary Participation Agreement

I, ____________________________________________________, desire to voluntarily participate in interviews, and to provide information as requested by “Weight Away Tampa Bay”.  In connection with my participation in the Program, I acknowledge, represent, warrant and agree as follows:

• 1. I am 18 years of age or older
• 2. I represent and warrant that I am not under the influence of any medications, drugs, or other substance that might impair my physical or mental ability to engage in the Program, or to complete the program.
• 3. I will follow all rules made and directions given by Weight Away Tampa Bay and each of their respective agents, representatives, employees and physicians in connection with the Program.
• 4. Weight Away Tampa Bay has no obligation to me whatsoever. I acknowledge and agree that there is no obligation to select me to participate in the Program. I also understand that I will not be paid any money or given any other consideration for signing this agreement.
• 5. MY PARTICIPATION IN THIS PROGRAM IS AT MY OWN RISK. I RELEASE WEIGHT AWAY TAMPA BAY, CESAR LARA MD, CESAR A. LARA, MD, CENTER FOR WEIGHT MANAGEMENT, ALL AFFILIATED COMPANIES, LICENSES, SUCCESSORS AND ASSIGNS, AND EACH OF THEIR RESPECTIVE OFFICERS, DIRECTORS, AGENTS, REPRESENTATIVES AND EMPLOYEES, AS WELL AS WISDOM HYPNOSIS AND DEBBIE LANE; AND ALL OTHERS CONNECTED WITH THE PROGRAM, FROM ANY AND ALL CLAIMS, ACTIONS, DAMAGES, LIABILITIES, LOSSES, COSTS AND EXPENSES IN ANY WAY ARISING OUT OF OR RESULTING FROM MY PARTICIPATION IN THE PROGRAM, AS WELL AS ANY AND ALL CLAIMS, ACTIONS, AND LIABILITIES FOR INJURY, LOSS OR DAMAGE TO ME, TO ANYONE ELSE OR TO ANY PROPERTY, REGARDLESS OF WHETHER OR NOT SUCH INJURY, LOSS OR DAMAGE WAS CAUSED BY THE NEGLIGENCE OR WILLFUL MISCONDUCT OF ANYONE CONNECTED WITH THE PROGRAM. I AGREE TO HOLD HARMLESS ALL COMPANIES AFFILIATED IN ANY MANNER WITH THIS PROGRAM, FROM ANY AND ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, EXPENSES, AND LOSSES, (INCLUDING ATTORNEY’S FEES) OF ANY KIND OR NATURE WHATSOEVER IN ANY WAY CAUSED BY OR ARISING OUT OF MY PARTICIPATION IN THE PROGRAM.
• 6. I understand and agree that any material I provide to Weight Away Tampa Bay, including but not limited to, photographs, biographical information, recordings, or any other type of material shall remain the sole property of Weight Away Tampa Bay.
• 7. If you are selected to be interviewed, you agree to authorize Weight Away Tampa Bay to conduct thorough investigations into your background and personal history which may include, without limitation, a criminal conviction check, and/or interviews with employers, neighbors, teachers, etc.

Dated_____________________________

Signature____________________________________________________________

weight-away-tampa-bay-program-application pdf

weight-away-tampa-bay-program-application1 Word