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.Format: (000) 000-0000.
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
Assumption of Risk
Waiver of Liability
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