Loading...

Meditation Waiver and Release of Liability

I have voluntarily enrolled in this Meditation activity.  I understand that I am under no obligation of any kind to participate in this Meditation event.  I understand that Meditation is a personal growth activity designed to enhance quality of life, and is not a substitute for medical diagnosis and/or treatment. 

I understand that this Meditation may involve physical, mental, intellectual, and emotional activity, including breathwork, which I may find strenuous.  I acknowledge my responsibility for exercising my own judgment in choosing to participate in this event.  By this consent I hereby knowingly and voluntarily assume the risk of any injury, be it physical or emotional, during the course of this event.  I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in this class.  I further acknowledge that the activities described above may be more mentally and/or emotionally demanding than my usual activities.

In consideration of my participation in this Meditation class, I hereby waive and release Charles Robinson and Kai Chi Do Inc. from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated arising from my participation in this class. 

I hereby agree to indemnify and hold harmless Charles Robinson and Kai Chi Do Inc. from and against any and all claims and expenses, including attorneys fees, arising out of my participation in this class. 

This Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 

I acknowledge that I have thoroughly read this Waiver and Release of Liability in its entirety and fully understand it.  By signing this document, I am waiving certain rights I or my successors might have to bring legal action or assert a claim against Charles Robinson and/or Kai Chi Do Inc.

January 25, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information about our services by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Check to receive information on becoming a Kai Chi Do Instructor.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver