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會員 / 學生註冊表 Membership / Student Registration Form

posted Sep 7, 2012, 7:16 PM by Charles Wong   [ updated Sep 7, 2012, 7:16 PM by bing wen ]




2012 -2013

會員 / 學生註冊表  Membership / Student Registration Form



 中文名Chinese Name:__________________________________________________________


英文名Name (Last):_______________________(First)________________________________




邮政编码Postal Code:____________  電郵E-mail:___________________________________

電話Phone#: (H)_____________________________  (W) _____________________________


紧急联系人Emergency Contact: ______________  联系電話 Contact Phone#: ____________





         課程  Courses                

Adult High School:


*     傳統楊式太極拳85 

             Traditional Yang Tai-chi Chuan 85 steps

*     陳式混元太極拳24                                

             Chen Hunyuan Tai-chi 24 steps

*     陳式太極拳56                          

             Chen Tai-chi Chuan (competition) 56 steps

*     式太極拳 37 

              Wu Style Tai-chi Chuan steps


**會員Member $ 65   會員Non-member $80


*     上學期

1st Term (Sept. 29 to Jan. 12)

*    下學期

  2nd Term (Jan. 19 to May 25) 



Dojang (261 Centrepointe Dr., Nepean):


*     太極劍42  (Dojang)                          

Tai-chi Sword 42 steps


14 weeks from Sept. 29, 2012


** 會員     Member $195

   會員Non-member $210





        <<<<<        请在背页签名Please sign the waiver form on reverse side        >>>>>

                                        學會專用  FOR OFFICIAL USED ONLY

    付款 PAYMENT              數額 $ AMOUNT             日期 DATE           負責人 RECEIVED BY          

   現款 Cash  $________________     __________________     _________________________ 

                               $________________     __________________     _________________________ 

   支票 Cheque           $________________     __________________     _________________________   

                               $________________     __________________     _________________________ 

細節REMARKS      ____________________________________________________________                                                                         


註冊號數Registration Number: _________________________________________________















I acknowledge that participation in OTCA classes and practices involves some risk of injury, illness, or loss of personal property.  I agree to release and forever discharge the Ottawa Taichi Chuan Association (OTCA) and the Board of Executives of OTCA, its members individually, and its officers, instructors, and teaching assistants, from any and all claims, demands, rights, and causes of action of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, including death, damages to property and the consequences thereof, resulting from my participation in the OTCA classes,  practices and related activities.


I certify that, to the best of my knowledge, I am in good health and physically capable of undertaking the OTCA classes, practices or related activities that I have registered to participate.


Acknowledgement of Understanding

I have read this waiver of liability, assumption of risk and indemnity agreement. I understand its terms and understand I am giving up substantial rights, including my right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of liability to the greatest extent allowed by law. My signature on this document in intended to bind not only myself but also my successors, heirs, representatives, administrators and assigns.



會員/ 學生Member  / Student Signature _____________________________


DATE __________________________________________________________


PRINT NAME ________________________________________________________



Question for New Members and Students:

How did you learn about OTCA, its classes and registration? 


  friends       OTCA website     another  website     Chinese newspaper     posters


  other (please specify)  __________________________________________________________