會員 / 學生註冊表 Membership / Student Registration Form

Post date: Sep 8, 2012 2:16:14 AM

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#: ____________

_____________________________________________________________________________

會員Membership

課程 Courses

Adult High School:

Dojang (261 Centrepointe Dr., Nepean):

傳統楊式太極拳85式 Traditional Yang Tai-chi Chuan 85 steps

太極劍42式 (Dojang) Tai-chi Sword 42 steps

14 weeks from Sept. 29, 2012

陳式混元太極拳24式

Chen Hunyuan Tai-chi 24 steps

** 會員 Member $195

非會員Non-member $210

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)

<<<<< 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) __________________________________________________________