2012
-2013
會員
/ 學生註冊表 Membership
/ Student Registration Form
____________________________________________________________________________
中文名Chinese Name:__________________________________________________________
英文名Name
(Last):_______________________(First)________________________________
地址Address:_________________________________________________________________
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式
Traditional Yang Tai-chi Chuan 85
steps
陳式混元太極拳24式
Chen Hunyuan Tai-chi 24 steps
陳式太極拳56式
Chen Tai-chi Chuan
(competition) 56 steps
吳式太極拳 37式
Wu Style Tai-chi Chuan
steps
**會員Member $ 65 非會員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式 (Dojang)
Tai-chi Sword 42 steps
14 weeks from Sept. 29, 2012
** 會員 Member $195
非會員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: _________________________________________________
OTTAWA TAICHI CHUAN ASSOCIATION
CLASS AND
PRACTICE WAIVER FORM
_____________________________________________________________________
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) __________________________________________________________