Taiji Ann Arbor Tai Chi Taiji
Home Instruction in Chen Style Tai Chi Ch'uan


WAIVER OF LIABILITY/INFORMED CONSENT

Before participating in Ann Arbor Tai Chi training please read, understand, and sign this consent form and return to Joe Walters. Also in PDF format for download here.

Group Fitness Class
Informed Consent Form

Please Print

Name of Participant (First and Last): ______________________________________________________

Street Address:_______________________________________________________________________

City: ______________________________ State: _______ Zip: ______________________

Home Phone: ____________________________ Cell Phone: ____________________________

Email:______________________________________________________________________________

Emergency Contact Name: _____________________________ Phone: _________________________

INFORMED CONSENT FOR EXERCISE PARTICIPATION

I desire to engage voluntarily in an exercise program given by Ann Arbor Tai Chi. I understand that the activities may be strenuous, and may require me to do body movement that I am not familiar with in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts. Should any unusual symptoms occur, I will cease my participation.

In signing this consent form, I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with fitness classes and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities.

AGREEMENT AND WAIVER / RELEASE OF LIABILITY

In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to:

  1. Waive, release and discharge from any and all liability to Joe Walters, and any appointed instructor,  or other students for my death, disability, personal injury, property damage, or property theft, or actions of any kind which may hereafter accrue to me in activities related to my training.
  2.  Indemnify and hold harmless Ann Arbor Tai Chi, and any of their instructors and students, from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity.

Therefore, intending to be bound and as a condition of being allowed to participate in the fitness class, have freely signed this waiver on the date indicated.

Participant Signature: _____________________________ Date: __________

Parent/Guardian Signature (Required if under 18 years old): ____________________________

Print Parent/Guardian Name: ________________________________________