會員 / 學生註冊表  Membership / Student Registration Form

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 中文名Chinese Name:__________________________________________________________

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

地址Address:_________________________________________________________________

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

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

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         課程  Courses                

OTTAWA TAICHI CHUAN ASSOCIATION

CLASS AND PRACTICE WAIVER FORM

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AUTHORIZATION AND WAIVER OF LIABILITY

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/ 學生簽名Member  / Student Signature _____________________________

日期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)  __________________________________________________________