Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

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Consent *

The San School of Tai Chi Chuan and San Healing Arts shall not be liable for any damages arising from personal injuries sustained by the applicant in, or about the premises of San Healing Arts or its affiliates. The applicant, in attending Tai Chi sessions and using the exercise facilities and equipment therein, does so at his/her own risk. The applicant assumes responsibility for any injuries or damages which may occur to himself/herself in, on, or about the premises of San Healing Arts or its affiliates, and does hereby full and forever release and discharge said school, its affiliates, its Directors, its Instructors and its agents from any and all claims, demands, damages, rights of action, or causes of action, present or future whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of the applicants use or intended use of the said schools and affiliates excercises, facilities and equipment thereof, including but without limitation any claims for personal injuries resulting from or arising out of the negligence of San Healing Arts, its affiliates, its Directors, its Instructors and its agents or the negligence of any other persons present on said premises including other persons using the said premises, whether they be members or non-members. The applicant undertakes and agrees that he/she will not teach Classical Yang Style Tai Chi Chuan, the San Tai Chi curriculum, nor claim affiliation with this school for credentials as a teacher without the express written consent and under the direct supervision of the Directors of the San School of Tai Chi Chuan.

Yes, I agree to all of the above.

No, I do not agree.