Wu’s Tai Chi Chuan Academy Detroit Waiver and Release Form
For Adult Beginning Student Status (Revised 4/3/2016)
Preamble
The learning of Tai Chi Chuan has assisted many men and women in pursuing a more active lifestyle through a system of practices which develop muscle strength, flexibility, balance and cardiovascular fitness. There are risks of injury or illness inherent in any training, exercise or fitness program. Moreover, I acknowledge that I have been informed that participation in Wu’s Tai Chi Chuan Academy Detroit (WTCCAD) classes and programs includes greater risks of injury or illness than many training, exercise or fitness programs because Tai Chi Chuan, as taught by WTCCAD, is a martial art that can involve realistic self-defense training and that I may be exposing myself to possible accidental risk of physical illness or injury in this program. I have also been informed that to avoid increased risk to myself during training, I might be required by WTCCAD or its instructors to wear certain clothing, footgear and/or safety equipment.
The WTCCAD Chief Instructor shall determine when a student is to be elevated from Beginning Student Status to Intermediate Student Status. Upon such elevation, the student shall be required by the WTCCAD to execute an additional, suitable Waiver and Release Form.
Waiver Conditions & Release
A. Signing this Waiver Is Required. I, ________________________, the applicant, understand that in order to participate in the Tai Chi Chuan training programs offered by the Wu’s Tai Chi Chuan Academy Detroit (WTCCAD), that I must read this Waiver and Release Form in its entirety, including the information set forth in its Preamble, and that I must sign and date the bottom of this Waiver and Release Form to show my consent to all of its terms and conditions. Prior to signing, I understand that I can ask my instructor, Chief Instructor or my physician or health care provider any question(s) about participation in WTCCAD classes and programs and/or can ask questions about the meaning and contents of this Waiver and Release.
B. Physical Ability to Participate. I understand that there are risks of injury associated with the training in the WTCCAD programs for all persons who elect to participate, with special medical risks for persons who elect to participate and who have conditions which include, but are not limited to: weight exceeding physician recommended maximums; conditions that affect the muscular-skeletal systems including but not limited to arthritis or other impairments of the knee(s), hip(s), ankle(s), back, neck and shoulder(s); medical conditions of the heart or lungs including but not limited to asthma or emphysema; immune conditions; diseases of the endocrine system and/or kidney(s); diabetes; consumption of tobacco or alcohol exceeding physician recommended maximums; drug use, legal or illegal, for recreational purposes; and/or age or general physical condition that could make illness or injury as a result of participation more likely.
I assure the WTCCAD and its authorized instructors that I am physically capable to participate in WTCCAD classes and programs without injury or illness. I recognized that it is most strongly recommended by WTCCAD that I consult with a physician or other health care provider prior to continuing in WTCCAD classes and programs, to insure that I am physically capable to participate in WTCCAD programs without injury or illness. However, whether or not I do consult with a physician or other health care provider, I understand that I am bound by this Waiver and Release as if I had consulted with my physician or other health care professional to ensure that I am physically capable to participate in WTCCAD programs without injury or illness.
In the event that WTCCAD or its instructors question my physical ability to participate in WTCCAD classes/programs without injury or illness, I agree that my participation in WTCCAD classes/programs may be suspended until medical confirmation of appropriate ability to perform is provided. The WTCCAD Chief Instructor shall determine the need for any medical confirmation of ability to participate which can trigger suspension. The WTCCAD Chief Instructor shall also determine the sufficiency of any medical confirmation provided. Upon suspension for medical reasons, the student shall automatically forfeit all fees and monthly dues already paid for past training to WTCCAD but shall be entitled to refund of payments made in advance for future training.
C. Responsibility and Option of Participant to Decline Participation. Each participant is required to participate in WTCCAD instruction and practice only to the extent of their own “comfort zone” which includes, but is not limited to, the responsibility to decline to participate, or to cease participation in a practice or activity once begun, where such participation causes pain, intimidation or fear of injury to the student. No student is required to explain a decision not to participate in a WTCCAD practice or activity unless that lack of participation is due to pain or other physical discomfort, in which case the student must immediately report their pain or other physical discomfort to the instructor or to the WTCCAD Chief Instructor.
D. Dismissal from participation in the WTCCAD program or classes. If my behavior and/or actions bring discredit to WTCCAD, or present unreasonable risks to other people or to myself, the WTCCAD may, at its discretion dismiss me from participation in all WTCCAD program or classes. Such behaviors and/or actions can include, but are not limited to, failing to follow instructions that relate to training and/or safety of my participation in classes or program. Other examples may include teaching of any Tai Chi Chuan classe(s) without express permission of the WTCCAD Chief Instructor or deception concerning the reasons for my participation in the WTCCAD program or classes. The WTCCAD Chief Instructor alone shall determine if there are grounds for dismissal of participation based on behavior and/or actions. Upon a dismissal, the student shall also automatically forfeit all fees and monthly dues already paid for past training to WTCCAD, but shall be entitled to a refund of payments made in advance for future training.
E. Photography and Video Imaging. I authorize the WTCCAD to utilize my still and/or video imaging of my participation in WTCCAD activities to be used, retouched, duplicated, reprinted, and/or transmitted by any means, for the purposes of advertising, promotions, including but not limited to any photographic and/or video sales, and any and all internet website use for the purposes of promoting WTCCAD classes/seminars/events and/or any future events of a similar nature.
F. Assumption of Risk and Release of Liability. After I have become informed of the risks and other conditions of participation in WTCCAD programs and classes, through the reading of this Waiver and Release Form as to which I have been able to ask any questions about it prior to signing, I knowingly and freely assume full responsibility for all anticipated and unanticipated risks of participation. I assume and release for myself and on behalf of my family, spouse, heirs, assigns and personal representatives, and release and hold harmless to the fullest extent permitted by law, WTCCAD, its agents, faculty, instructors, employees, members, visitors, and other students, from any and all claims, suits, damages or liabilities, whether arising from negligence or otherwise, for any and all injury or illness, loss of property, disability or death arising out of my participation in the WTCCAD training program. The release of liability in this waiver shall also be extended to any sponsor of the WTCCAD program and to the facility where WTCCAD instruction and training is conducted.
I hereby freely and voluntarily execute and deliver this release and agreement of waiver and assumption of risk in consideration of the Wu’s Tai Chi Chuan Academy Detroit permitting me to participate in its program and receive instruction in Tai Chi Chuan. By my signature below, I affirm that I have read, understood and agreed to all of the above terms and conditions.
Print:________________________________________/Sign: ________________________________________
Date: __________ Address: _________________________________________________________________
Phone: _____________________________________ Email : ___________________________________
Received & Approved by WTCCAD: _____________
