Phoenix T’ai Chi Centre

708-82 Ridout St S

London ON  N6C 5H6

Registration Form

For insurance purposes we require the following:

LIABILITY RELEASE.. I understand that with T'ai Chi and Qigong, being physical activities, there can be an inherent element of risk in participating in them. By my enrolment in and attendance at classes/seminars, I fully assume responsibility for this risk. Therefore I do hereby for myself, my heirs, executors, administrators and assigns 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: _____________________________________   Dated: ___________________

Witness: __________________________________________________  Dated: ___________________

This form must be signed and dated prior to participation in any class or seminar.