Waiver and Release of Liability

Name

First Name

Last Name

Email

Telephone where we can reach you the day of a session, in case we need to make changes and let you know:

Do you have any health conditions or restrictions which might affect your ability to perform certain exercises, and of which your instructor should be notified?

Yes

No

If yes, please describe

Do you have any experience of Tai-Chi or QiGong, or martial arts, or yoga, or meditation?

Yes

No

If yes, please describe

Check if you agree with the waiver below.

I read the entire Waiver and Release of Liability below, and I agree with all its terms.

TAI-CHI and QIGONG WAIVER AND RELEASE OF LIABILITY

This program is brought to you with your well-being and safety in mind.

By joining any Tai-Chi/QiGong or wellness program with Patricia Beretta, whether in-person classes, private lessons, workshops, or video / online classes, private lessons, workshops, you are agreeing to this Waiver and Release of Liability.

When joining an online or video program, you are kindly invited to make sure that you are following it in an environment that is safe for you and people around you.
Thank you for making sure that you checked with your doctor that it is safe for you to engage in such in-person or video / online activity. If you have not checked with your doctor, you are taking the full responsibility to participate at your own risk and in an informed manner.

Make sure that you stay within your zone of comfort at any time. This means that you are invited to adapt or stop any move or posture that is uncomfortable for you, at any time. If you need to sit or take a break, please take it easy and do so. During live online sessions, the instructor may not be able to see you for a number of reasons: if your camera is disabled, for various technical reasons, or because the instructor’s view does not show your camera. As such, you should exert extra caution, assuming that the instructor cannot see you, and you are responsible to stay within your zone of comfort. Whether with live or recorded sessions, you understand that you are following online material at your own risk.

By joining this program, you are confirming that you understand the risks of engaging in physical exercises practiced in a Tai-Chi/QiGong or wellness program, and that including physical activities, such programs may be too strenuous and demanding for certain individuals. You are also confirming that you will not hold the instructor personally liable for any damage, ill effect or injury, incurred before, during, or after the sessions from this program. You therefore release and discharge Patricia Beretta, “Courtland Acupuncture”, “Qi Intelligence”, and any person connected with “Courtland Acupuncture” or “Qi Intelligence”, as well as the owners/managers of facilities where you attend in-person sessions, from any liability for injury or loss that you may have by reasons of participating in these programs. You further understand that Patricia Beretta, “Courtland Acupuncture”, “Qi Intelligence”, and any person connected with “Courtland Acupuncture” or “Qi Intelligence”, as well as the owners/managers of facilities where you attend in-person sessions shall not be liable for the loss or theft of or damage to the your personal property.

You will also release the instructor from any claims, demands and causes of action arising from your voluntary participation in this program, for yourself, your heirs, executors and administrators.