Naoko Otani LMT Private Tai Chi Waiver Form

Tai Chi Private Lesson by Naoko Otani LMT

(310) 936-0284

naokootanilmt@gmail.com

Congratulations on embarking on a journey of learning Tai Chi. Learning Tai Chi requires patience, determination and a lot of practice. However, the reward is priceless. You will acquire peace that you can take with you anytime, anywhere and lifetime.
Date of first lesson*

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Full Name*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Can I text you?*

YesNo
Have you learned Tai Chi before?*

NoYes (When and what style of Tai Chi?)
Why do you want to learn Tai Chi?*
How often do you want to take a Tai Chi lesson?
Do you have any pain?*

NoYes, alwaysYes, when I do ....... (describe when and where))
Do you have any physical limitations? If yes, please describe.
Have you had any injuries? If yes, please list.
Do you have any other medical conditions that I should be aware of?
How often do you exercise and what kind?
What is your learning style? In what way do you learn the best? Please select up to two.*

ListeningReadingWatching and doingTaking notesSaying it aloudOther (please describe)
Is there anything else you would like to tell me or ask me?
Cancelation Policy

I understand that cancellation of the appointment must be made at least 24 hours in advance, and if I missed the appointment without notifying (no-show), I will be charged 50% of the fee for the lesson.

Waiver

I accept that neither the instructor nor the facility is liable to any injury or damages to person or property, resulting from taking Tai Chi private lessons. I understand that Tai Chi requires physical movement, and I assume responsibility for any risk or injury I may sustain as a result of my participation in the lessons.
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