Eli
Montaigue Taiji Workshop
September
17 & 18, 2011
Ottawa,
Ontario
Name ____________________________________________
Address
___________________________________________
___________________________________________
Phone
___________________________________________
E-Mail ___________________________________________
The cost of this workshop is $200.00
payable with this registration form.
Please send the above form and the signed waiver and release form (below) and your payment to:
Josephine Anderson
570 Byron Avenue
Ottawa, Ontario
Canada K2A 0E4
Further details as to location and exact
start and end times of the workshop will be sent to you as available. If you have any questions, please contact
Josephine at
(613) 729-9991 or doubledragonott@aol.com
Eli Montaigue will covering the Old
Yang-style form - Yang Lu Chan form, Bagua, Small San Sau and elements of push
hands.
Thank you.
WAIVER AND RELEASE
OF
LIABILITY
I, the undersigned, acknowledge that I am
applying for instruction in Tai Chi with the Double Dragon Tai Chi Studio and,
in consideration of being allowed to participate in this instruction, and other
activities, I hereby:
1.
Acknowledge that some
activities may be physically demanding and carry with it certain risks. These risks include, but are not limited to
physical injury, disability or death.
2.
Agree that prior to
participating, I have a right and duty to inspect the facilities and equipment
to be used and if I believe that anything is unsafe or beyond my ability, I
will immediately advise my instructor of any such condition(s) and refuse to
participate.
3.
Agree that, knowing the risks
involved in the exercise and martial art of Tai Chi, I assume the risk and
accept personal responsibility for any damages incurred by my participation.
4.
Release Double Dragon Tai Chi
Studio, Josephine Anderson and any other instructor, or person acting as an
instructor (the releasees), from any and all liability, claims, demands, losses
or damages on account of injury, including permanent injury and death, or
damage to property, caused or alleged to be caused in whole or in part by any
releasee, including those damages caused, or alleged to be caused by their
negligence and I waive all rights to, and covenant not to, sue or be otherwise
compensated by the releasees, their heirs, successors or assigns.
5.
Bind my estate, heirs,
successors and assigns to this release and wavier.
6.
Acknowledge that I have read
the above waiver and release and understand that I am giving up substantial
rights by signing it and, knowing this, sign it voluntarily.
7.
Acknowledge that I am agreeing
to participate knowing the risk and conditions involved and do so entirely on
my own free will.
____________________ _____________________ _________________
Participant Signature Date