Full Name
Address including postal code
Phone primary number
Phone 2 secondary number
Phone 3 another number?
Birthday
Height
Weight
Married? --select-- married single
Occupation
E-mail
Referred by... How did you hear about us?
Medical note Any medical condition which the instructor should know about?
Who is your Doctor?
Doctor's address
Doctor's phone
Medical referral? Have you consulted a medical professional regarding these classes? yes no
Goals What do you want to get from these classes?
Tai Chi
Qigong
Kungfu / Wushu
Modern Wushu
Karate
Yoga
Other Martial Arts
Waiver By checking the box above, I acknowledge and I am aware that tai chi (taijiquan), qigong (chi kung), kungfu, and all martial arts are physical activities in which injury may occur. In consideration of my acceptance as a participant in these classes, I do hearby remise, release and forever discharge Cloud Mountain Martial Arts, 1580442 Ontario Limited, Ian Sinclair 1051098 Ontario Ltd., their employees, agents, officers, principals, landlords, tenants, successors and assigns, and other persons, firms, associations or bodies corporate participating in or connected with any lesson, practice session, game, or other associated event and waive any right, claim or action for damages, compensation and liability or for negligence of any nature whatsoever arising from my participation in such activities.
Today's Date mm-dd-yyyy
Mon. 6 pm
Tues. Noon
Wed. 6 pm
Saturday 7 am
Mon. 7 pm
Tuesday 6 pm
Wed. 7 pm
Thurs. Noon
Thurs. 6 pm
Sat. 8 am
Mon. 8 pm
Wed. Noon
Wed. 9 pm
Mon. 9 pm
Wed. 8 pm
Sat. 9 am
Tues. 7 pm
Thurs. 7 pm
Sat. 10 am
Tues. 8 pm
Thurs. 8 pm
Sat. 11 am
Tues. 9 pm
Thurs. 9 pm
Sat. Noon
Tues. 4 - 6 pm
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