TTC Registration Form

The Taiji Centre Registration Form is a rather long legal document that is required by my regulating peak body for Chinese Martial Arts (KWA) and for the Insurance cover KWA provides.

It sets out the information to be recorded by the participant and the obligations of both the Participant and the Provider.

The form is available for completion and witnessing before the start of the first trial session. It requires 2 signed declarations to be witnessed: 1. That the Participant agrees that the form has been read and understood and the second that the conditions imposed by the activity are consented to.

Please excuse the formatting of the document below. It is provided as a “Read Only” file and is not suitable for printing off for the TTC class purpose.

The Taiji Centre (TTC)
24 Mathison Circuit
Churchill Vic 3842
ABN 23 830 670 998
Find Your Centre with Taiji (Tai Chi) …the Way of Balance

THE TAIJI CENTRE REGISTRATION FORM: ALL VENUES (RF2015-16.4)

  1. APPLICANT’S DETAILS:Last Name: ……………………………………………………………………………………………………………….. Given Names:……………………………………………………………………………………………………… Address: …………………………………………………………………………………………………………………… Postcode:…………………..Ph (home)………………………Ph (work)………………………………………Email:………………………………………………………………………………………….

    Mobile-Phone:………………………………………………………………………………… Occupation:………………………………………………………….Date of Birth………………………………

    Name of Employer:……………………………………………………………………………

  2. HEALTH DECLARATION: (Answer 1- 4 & use back page if more space is required)1.Are you prescribed drugs, which may impair reaction time or judgment?
    YES* / NO If yes, what drugs……………………………………………………………………..2. Have you suffered any incapacity requiring medical attention in the past 12 months? YES* / NO If yes, give details…………………………………………………………………….

    3.Name and identify any physical impairment, injury or medical condition that currently affects you…………………………………………………………………………………….

    4.Are you aware of any health problem that you have that, in the interests of your safety, which the academy/club should be advised of? YES* / NO If yes please describe:

    ………………………………………………………………………………………………..

    ………………………………………………………………………………………………..

    * A Medical Certificate will be required to support your attendance if you have a medical condition. Only your treating health professional is qualified to advise. See also the Health Declaration p3 (b)

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3. TAI CHI HISTORY

2.

Have you studied TAI CHI before? YES / NO Please state particulars, if known:

Previous Style………………………………………..Grade if applicable:…………………. Number of years studied:…………Name of your instructor/s……………………………… List any other Tai Chi courses commenced: ……………………………………………………………………………………………….. ………………………………………………………………………………………………… …………………………………………………………………………………………………

  1. EXCLUSION OF APPLICANTHave you ever been excluded from TAI CHI, by a medical practitioner, or any other person, entity, or TAI CHI Club? YES / NOIf yes, give details …………………………………………………………………………………………………….. ………………………………………………………………………………………………..
  2. DECLARATION OF UNDERSTANDINGI have read and understood the terms of the TAI CHI Contract or if I did not understand the terms of the Contract I requested an independent person to explain them to me.Dated this …………………………………..day of…………………………………………………20…………… Applicant Signature……………………………………………………………………………………………………. Witness signature………………………………………………………………………………………………………..

6 GUARDIAN’S CONSENT: (for all applicants who have a legal guardian including if under 18)

I hereby certify and decree that all the information contained in the declaration above is true and accurate.

Signature…………………………………………………….Relationship to Applicant………………………… Address in full ……………………………………………………………………………………………………………

RF2015-16

3.

THE TAIJI CENTRE – TAI CHI CONTRACT

The following conditions must be read carefully:

  1. Interpretation”the Applicant” means the individual who signs this Contract and agrees to be bound by its terms. The applicant’s Legal Guardian must also sign if applicable, including for an applicant under 18 years of age.
  2. Acceptance
    I, (full name of the APPLICANT)…………………………………………………………………………………..of (RESIDENTIAL ADDRESS)…………………………………………………………………………………. .I, (full name of the GUARDIAN)…………………………………………………………………………………. of (RESIDENTIAL ADDRESS of GUARDIAN) ……………………………………………………………..the Applicant, hereby agree to be bound by the terms of this Contract with The Taiji Centre and the persons named and described in Schedule 1, hereinafter jointly and severally referred to as “the providers”. The providers agree to permit me to use their premises and facilities for Taiji, to instruct me in Taiji and related activities (“the service”) upon and subject to the following terms and conditions:

(a) Club Fees

The Applicant will pay on demand the prescribed or stated fees for the service. Such fees may be notified to the Applicant by letter or memorandum or by notice displayed in the provider’s premises or premises occupied by the provider or verbally.

(b) Medical Conditions

The Applicant warrants that he or she has not at any time suffered any blackout, seizure, convulsion, fainting or dizzy spells and is not presently receiving treatment for any illness, disorder or injury, which would render it unsafe for the Applicant to take part in Taiji. The applicant further warrants that he/she has provided information on nay and all pre-existing medical conditions.

(c) Exclusion of Applicant

The Applicant warrants that he or she has not at any time been excluded from Taiji by a medical practitioner or any person or entity including a Taiji club /organisation.

RF2015-16

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4.

(d) Rights of a Consumer

If the Trade Practices Act 1974 or similar state laws apply to this agreement then certain terms and rights may be implied into this contract, which operates for the benefit of the Applicant. Under the provision of that legislation, those terms and rights, and any liability of the supplier flowing from them, cannot be excluded, restricted or modified by any provision of the contract.

PLEASE NOTE THE FOLLOWING:

If the Trade Practices Act 1974 or similar state laws operates so as to prevent the exclusion, restriction or modification of warranties otherwise implied by those laws then the liability of the offer for breach of those warranties is limited to:

(i) the re-supply of the Taiji instruction and related activities; or
(ii) the payment of the cost of having the Taiji and related activities supplied again.

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(e) Waiver and Indemnity

In all other cases and except where inconsistent with the above, the Applicant for him/herself, his/her executors, administrators, dependents and other personal representatives, hereby absolves and indemnifies the providers and all their servants, agents, employees and other students or persons under the providers control (the “indemnified”) from all liability howsoever arising for injury or damage (including but not limited to the Applicants’ person, whether fatal or otherwise, property and personal belongings) however caused including by the negligence of the indemnified, arising out of or participating in Taiji or in connection with Taiji or in anyway caused by, or arising out of, any activity carried on by the indemnified.

I, the Applicant, agree to occupy and use the premises of The Taiji Centre academy at risk to myself and release to full extent permitted by law, Julie Lucas, head instructor, The Taiji Centre academy, and its agents, servants, contractors and employees from all claims and demands of every kind in of or resulting from any accident or damage to property or injury or death to myself while undertaking training in Taiji with The Taiji Centre academy.

(f) TAI CHI done at Applicant’s own Risk

Any person training in Taiji, or in activities connected with Taiji or participating in any activity carried on by this Club/Academy Company are only allowed to do so on the distinct understanding that they do so entirely at their own risk.

(g) TAI CHI not to be taught by Applicant

The Applicant agrees that he/she is in no way qualified or authorised to teach The Taiji Centre Tai Chi publicly or privately in any way whatsoever for personal, monetary or any form of gain whatsoever unless with the written authorisation of The Taiji Centre.

RF2015-16

5.

(h) Agreement to abide by the Academy Rules

I, the Applicant, agree that I will abide by The Taiji Centre Class Code of Conduct and agree and acknowledge that any failure to abide by rules of the Code of Conduct may result in my expulsion from the Academy.

(i) Acceptance

Performance of the provider’s obligations under the contract may be effected by any one or more of the providers, either jointly or severally.

(j) Governing Law

Any agreement entered into pursuant to this acceptance is to be governed by the
laws of the State of Victoria and Australia. The Courts of Victoria and Australia
shall have exclusive jurisdiction to entertain any action in respect of any such agreement.

(k) Statement of Understanding

I, the Applicant have read, or have had read to me the above conditions and having understood the same, I consent to the activities proposed.

Signed (Applicant) …………………………………………………………………………………………………….

This (date) …………………………………day of (month…………………………………………..20……….

in the presence of (signature of witness) ……………………………………………………………………… [This contract must be signed by a guardian if the Applicant is under the age of 18.]

SCHEDULE 1

In addition to The Taiji Centre, and its owner and instructor, Julie Lucas, the providers in respect of this agreement include, but are not limited to the venue providers

  1. (i)  Churchill Lumen Christi Catholic Primary School Council (Eco- Centre)
  2. (ii)  Latrobe City Council (T.E.C.H.-Traralgon, Kernot Hall- Morwell)
  3. (iii)  Morwell Neighbourhood House Learning Centre Inc (MNHLC facilities)
  4. (iv)  Latrobe Theatre Co. (“Wings”, Ronald Reserve Hall, Morwell)
  5. (v)  Morwell District Girl Guides, (Morwell Guide Hall)
  6. (vi)  Churchill Neighbourhood Centre Inc, Community Hub, Churchill

and their principle representatives, agents, servants, contractors and employees.

RF2015-16.4

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