New Student Registration New Student Registration Welcome to Ji Hong Tai Chi & Qi Gong First Name (required) Last Name (required) Cell Number (required) Email (required) Emergency Contact Name (required) Emergency Contact Number (required) How did you find out about us? (required) ---InternetFamily / FriendHealth ProfessionalNewspaper / MagazineFlyer / PosterCommunity Recreational GuideTV / RadioOthers I recognize that the programs offered through Ji Hong Tai Chi may involve physical activity including, but not limited to: whole body strengthening and stretching, cardiovascular conditioning, and other various fitness exercises. Activities may also include the use of equipment including, but not limited to: long poles, elastic bands, swords, spears, broadsword. Activities can take place at premises operated by Ji Hong Tai Chi or at other public and private properties. I hereby affirm that I do not suffer from any known physical or mental disability or condition that would prevent my participation in this program or related activities, and, if required, will consult my physician or health care professional for clearance. I acknowledge that my enrollment and subsequent participation is purely voluntary and is in no way mandated by Ji Hong Tai Chi. I fully understand that I may injure myself as a result of my enrollment and subsequent participation and I hereby release Ji Hong Tai Chi and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, strokes, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, injuries to knees or other joints of the body, injuries to back, injuries to a foot, heat prostration, or any other illness or soreness that I may incur, including death. * By checking this box I hereby confirm that I have read and understood the above terms.