TaiChi in the Park – Registration (2026)
Thank you for your interest in Tai Chi in the Park. Please complete this form to reserve your spot. If you have any questions, feel free to reach out
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age Group
Please Select
• Under 40
• 40–54
• 55–64
• 65+
Have you practiced Tai Chi before?
No, this is my first time
A little experience
Yes, regularly
What brings you to this program? (Select all that apply)
Improve balance
Fall prevention
Stress reduction
Gentle exercise
Social connection
Curiosity/ learning something new
Other
Which sessions do you plan to attend?
Full program (recommended)
Drop-in (select dates below)
Do you have any injuries or health concerns we should be aware of? (Optional)
Emergency Contact Name & Phone (Optional but recommended)
Liability Waiver Agreement (Required) I understand that participation in Tai Chi involves gentle physical movement. I agree to practice at my own pace and take responsibility for my safety. I release Mindful Taichi Co. and instructors from liability for injuries related to participation.
*
I agree
Would you like to receive updates about future programs?
Yes
No
Registration Fee
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( X )
Full program (15 sessions)
Recommended
$
180.00
Quantity
1
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9
10
One session
Please select the number of sessions
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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