Wednesday TaiChi Lesson: Sign Up Form
Lesson Fees: Pay As You Go

1. 60 minutes
2. $40.00/Lesson


Release of Liability Waiver  – USA Shaolin Xiu Culture Centre  

Please read the following carefully. By submitting this form, you acknowledge and agree to the terms below.

USA Shaolin Xiu Culture Centre (“The Center”) is committed to conducting its activities in the safest manner possible. The safety of all participants is our highest priority. However, participants and/or parents/guardians must acknowledge that there are inherent risks of injury associated with participation in recreational and martial arts activities. The Center continually strives to minimize such risks and requires all participants to follow established safety rules and instructions designed for their protection.

In consideration of being permitted to participate, or allowing myself or my child to participate, in Kung Fu, Tai Chi, Qi Gong classes, programs, private lessons, or any activities associated with The Center, I acknowledge that such activities involve risks greater than those encountered in everyday life. I voluntarily assume full responsibility for any risks, injuries, damages, or losses that I or my child, or our family, may sustain as a result of participation.

I hereby waive, release, and discharge The Center, its owners, instructors, employees, and volunteers from any and all claims, demands, causes of action, damages, liabilities, costs, or expenses (including attorney’s fees and court costs) arising out of or related to participation in these activities.

I authorize The Center and/or appropriate medical personnel to administer emergency care, including first aid and evacuation, as deemed necessary for the safety and well-being of myself or my child while under The Center’s supervision.

In the event of a medical emergency, I understand that I or my child may be transported to a medical facility by emergency services if deemed necessary. I acknowledge that any costs associated with such transportation and treatment are my responsibility.

I understand that, in certain situations, The Center staff may need to contact emergency services prior to notifying a parent, guardian, or physician. I agree to indemnify and hold harmless The Center, its owners, employees, and volunteers from any claims, losses, or expenses arising from actions taken on behalf of myself or my child.

I grant permission to The Center and its authorized agents to photograph, film, or otherwise record me or my child during participation in activities and to use such media for promotional or educational purposes without compensation.



USA Shaolin Xiu Culture Centre
24727 Sadddlespur Ln.
Katy, TX 77494
832-363-7994


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Student's Last Name: *
Student's First Name: *
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Has the participant ever been seriously injured?
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Class Schedule *
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I have read and understand this Release of Liability Waiver and I voluntarily affix my name in agreement. *
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