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
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
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