free class Registration Form

Tai Chi Sign Up Form

Saturday, March 29th at 10:30am - Golden Lion Martial Arts-Sausalito
Please summit this application and wait for confirmation
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Parent/Guardian Name (If student is under 18)

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Preferred Contact Method
For a future Tai Chi class, please pick what time of day works best for you ?*

Saturday at 10:30amMonday at 3:30pmThursday at 7:30pm
Waiver

The student hereby represents that they are physically fit to take the prescribed course of instruction. The student further acknowledges that the existence of some risk of personal injury in participating in said prescribed course of instruction, and that the student is assuming this risk without liability to the school, owner, instructors, family members or Landlord, by executing this agreement and participating in said course of instruction.
I have read, understood and agree to be bound by the above statement. If under 18, parents or legal guardian must sign.*

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Date*

MonthDayYear
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Tai Chi Sign Up Form