Tai Chi for Health Registration Form
Please fill out this Tai Chi for Health Registration Form, Release Form & Acknowledgement of Personal Responsibility/Consent in order to register for a class / classes.

If registering for an in-person course you agree that you will wear a mask or face covering during class time if physical distancing of six feet or more between individuals is not possible to maintain at all times.

Tai Chi helps empower people to improve their health and wellbeing through slow, smooth and continuous mind-body exercises. While developed by the Tai Chi for Health Institute to bring health benefits as quickly as possible for specific conditions, all courses are appropriate and beneficial for people of all ages and levels of physical ability.
I would like to register for the following online course(s):
Participant name (first and last): *
Phone number: *
Email address: *
Emergency Contact (Name and phone number)
Do you have any medical condition which may affect your learning and practicing tai chi? *
If you answered “yes” to the previous question, or if you are unsure you must have a doctor’s clearance before you take this class. Doctor's Clearance:
Clear selection
I consent to the use of any photographs or videos taken of me, as well as my feedback or written comments by me in connection with the class for publicity, promotion, demonstration or other business purposes, in any medium, including the internet, and waive any right to compensation in connection with such use. *
I would like to receive limited communications from Healthy Acadia about their programming and services in our communities. *
While classes are free, please consider donating to offset the costs and ensure tai chi is available across our communities now and in the future. Donations can be made online at https://healthyacadia.org/donate (with "Tai Chi" and the instructors name in the notes) or sent to: Healthy Acadia, 140 State Street, Suite 1, Ellsworth, ME 04605. Thank you!
By typing my name below, I acknowledge and understand that tai chi is a gentle exercise, which may enhance my physical fitness. I confirm that my physical fitness is at a sufficient level to safely participate in this class. In consideration for admission to this class: (a) I hereby accept full responsibility for and assume the risk of any injuries sustained because of my participation in this class, practice, or lessons involving tai chi; and (b) I hereby release and hold harmless the instructor, Healthy Acadia and its partner sites, for any liabilities, injuries and expenses which may arise as a result of participation in this class or practice or lessons involving tai chi. I acknowledge that typing my name below equates to a physical signature. *
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