Membership / Class Registration Form

Full Name*

First NameLast Name

Phone Number

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Email*

example@example.com

Address

Street Address

Street Address Line 2

City, Postal Code

Emergency Contact Details (required)*

First & Last NameRelationship to you

Emergency Contact Phone Number*

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I am:*

a new membera returning memberother (contact info change, etc)

I want to register for:

Seated classes at Crofton (Mondays 2pm)Gentle Tai Chi at St. Peter's (Fridays 11 am)Intro Part 1 at The Hub (Tuesdays at noon)Intro Part 1 at St. Peter's (Wednesdays at 10 am)None! I am familiar with the entire 108 moves of the set and am free to attend any of the other classes as often as I wish.

Oh no! The class you have chosen is now full. Please watch the website for the new term schedule starting in June 2026. (Registration will open on May 10 for those classes.)

Member dues can be prepaid for a 4 month term ($125), or for the full year ($300).

E-transfer is encouraged (to CowichanValleyTaiChi@gmail.com)

or cheque (made out to Canadian Tai Chi Academy).

How will you be submitting your payment?*

E-transferCheque to instructorCash to instructor

Please indicate your age range:

20 - 4041 - 6061 - 7575+

What would you like to get out of Tai Chi?

Provide any health concerns you may have:

How did you hear about us?

Canada’s Anti-SPam Legislation (CASL) Consent

The applicant consents to receiving by e-mail or other form of electronic contact, the Canadian Tai Chi Academy's (the “Academy”) publications, event invitations, announcements and other commercial electronic messages ("CEMs"). The applicant understands that this consent to receiving the Academy's CEMs may be withdrawn at any time by e-mail at [support@canadiantaichiacademy.org].

Voluntary Release & Waiver

In consideration for being permitted by Canadian Tai Chi Academy to participate in the Academy’s Activities, for myself, my spouse, heirs, legal representatives and assigns, hereby assume all risks for such involvement, and release and discharge the Canadian Tai Chi Academy, its affiliates, agents, officers, and employees, from all liability, claims, demands, actions and causes of action whatsoever, whether known or unknown, arising out of or relating to any loss or damage that may occur either directly or indirectly from my participation in such activity.
I enter into this VOLUNTARY RELEASE & WAIVER willingly and with full knowledge and understanding that by submitting this form, I am expressly releasing the Canadian Tai Chi Academy from any liability arising from instruction or use of facilities and equipment while engaging in the Academy’s activities.

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Membership Form