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
$
180.00
Quantity
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One session
Please select the number of sessions
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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