Tai Chi Five Evening 1st Feb Jan 2022 Registration Form
If you have any health concerns, please consult with your Dr before taking part in class. Your instructor will treat all info confidentially.
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4 week online courses on Tuesdays at 7:30-8:30pm
Name *
Address *
Contact number *
Email address *
Age group *
Previous Tai Chi Experience *
How did you hear about us? *
Emergency contact name *
Emergency contact phone number *
Do you have any of the following medically diagnosed? *
Required
Are you pregnant? (If applicable)
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Please list any current health issues if necessary
Please list any medication, and what it is for, if necessary
Do you agree to be contacted by the instructor to remind you of class each week? *
Are you happy for the instructor to retain your contact details for her to inform you follow up classes? *
Declaration: I have been honest and accurate about my state of health, and have consulted a GP about any health concerns before taking part in this gentle to moderate exercise. I will inform my teacher if there are any changes in my health, so that she may give me the most appropriate tuition for my needs. I will pay attention to the needs of my system, and only do what I can comfortably, resting when necessary. *
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