Qigong Vitality Waiver Release Form

Qigong Vitality Waiver Release Form

Please read carefully and complete all sections to participate in the class.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name and Phone Number*
Acknowledgment of Physical Nature of Qigong*

I understand that Qigong involves physical movements and postures that may carry inherent risks.I acknowledge that I am physically capable of participating in Qigong classes.
Assumption of Risk*

I voluntarily assume all risks associated with participating in Qigong classes.I understand that injuries can occur and I accept full responsibility for my participation.
Waiver of Liability*

I release and hold harmless the instructor and organization from any liability for injuries or damages incurred during the class.I agree not to hold the instructor or organization responsible for any accidents or injuries.
Signature and Date to Confirm Agreement*
Signature (Type your full name)*
Date of Signature*

Hour Minutes

AM/PM Option
Qigong Vitality with Marianne
Should be Empty:

Qigong Vitality with Marianne