Phoenix T’ai Chi Centre
Registration Form
Name:
Street:
City, Prov
Postal:
Phone:
Email:
In case of accident notify:
Relevant health info:
How did you learn of us?
Please make cheques payable to: Phoenix T’ai Chi Centre
I recognize that there is an inherent risk in participating in any exercise including T’ai Chi and
Qigong. By my enrolment in and attendance at T’ai Chi and Qigong classes & seminars, I fully
assume responsibility for this risk. Therefore, in consideration of you accepting my registration
for enrolment, I hereby for myself, my heirs, assigns, executors, and administrators remise,
release and forever discharge "Phoenix T'ai Chi Centre", its agents, principals, employees,
instructors, their heirs, executors, administrators, successors and assigns and any other person
connected with "Phoenix T'ai Chi Centre" of and from all manner of actions, causes of action,
claims or demands which, against "Phoenix T'ai Chi Centre", the undersigned ever had, now has
or may hereafter have by reason of participating in the activities of "Phoenix T'ai Chi Centre" or
from using its facilities including, but without limiting the generality of the foregoing, any claims
for personal injuries resulting from or arising out of the negligence of "Phoenix T'ai Chi Centre"
or its principals, employees and instructors. I further understand that "Phoenix T'ai Chi Centre"
shall not be liable for the loss or theft of or damage to the personal property of the undersigned
Participant under any circumstance whatsoever.
Further, I understand that T'ai Chi and Qigong, being physical activities, may be too strenuous
and demanding for certain individuals and that it is suggested that if I have any doubts, I consult
a physician before engaging in these exercises, or other related activities.
Signature of Participant: __________________________________
Date: _______________
I agree to receive electronic messages containing news and upcoming events
from Phoenix T’ai Chi Centre.
This form must be submitted, signed and dated, prior to participation in any class.
www.phoenixtaichi.ca
519-439-8875
info@phoenixtaichi.ca
mailing address: 708-82 Ridout St S, London ON N6C 5H6