INTERNATIONAL TAOIST TAI CHI CENTRE RESERVATIONFORM

Personal Information  Original Reservation  Revised Reservation

First Name / Last Name / Date of Birth (dd/mm/yy) /  Male
 Female
Street Address  Same as previous reservation / City
Province/State / Postal/Zip Code / Country
Primary Phone  Home  Work  Cell / Secondary Phone Home  Work  Cell / Email
Society Branch and Region / Instructor
 Beginner  Continuing
Emergency Contact: Name, Relationship and Telephone Number

Purpose of Reservation

Workshop/Event Name(s)and Date(s)
1. / Volunteering – Start Date (dd/mm/yy)
2. / End Date (dd/mm/yy)

Arrival and Departure

Travel Mode / Arrival Date (dd/mm/yy) and Time / Departure Date(dd/mm/yy) and Time
OWN CAR
Other (explain)______
AIRPORT Please wait OUTSIDE at the arrivals level of YOUR TERMINAL for all programs, except CIT week. / Airline______
Flight#______/ Airline______
Flight#______
UNION TRAIN STATION Please stand by the large VIA RAIL sign outside the main entrance on Front Street. / Train#______/ Train#______
TORONTO BUS DEPOT - Please wait at the corner of Elizabeth Street and Edward Street. / Bus#______/ Bus#______
Pick Up Drop Off Request /  I would like to be picked up /  I would like to be dropped off

Upon your arrival, and after you have claimed any luggage and proceeded to the designated pickup area,you may call the Centre (collect, if necessary) at 519-941-5981 to confirm your arrival. Please display a visibleTai Chi logo.Please watch vigilantly for our marked Tai Chi vehicle.

Accommodation

 Room  Other:______
 Special requirements due to health reasons(please explain):

Beds are assigned according to need. We request that seniors and those with health concernsgive two weeks’ notice in order to be given priority.

Meals

 Regular  Vegetarian  Special diet (see notes)

Important waiver, indemnification and consent (Please read carefully before signing)

I, the undersigned, hereby waive all rights that I may have against you to sue for any injury suffered by me or my death or for any injury to or loss of my property or property in my possession and this waiver shall be binding upon my heirs, assigns and successors. I further promise to indemnify and save you harmless from all claims (including claims under the Family Law Reform Act of Ontario and similar acts) against you as a result of injury to me, my death and loss or damage to my property or property in my possession and this indemnity shall be binding upon my heirs, successors and assigns. I hereby further agree to indemnify you and save you harmless from any claims against you arising from the injury or death of any minor under my care or control or the loss of or damage to property belonging to or in the possession of such a minor. I agree to conduct myself in a reasonable and responsible manner when at the Centre and to abide by its rules, policies and practices. In consideration of my instruction in Taoist Tai Chi (incl. all forms and meditation taught at the Centre), I undertake and agree not to teach Taoist Tai Chi without the express consent and the direct supervision of the Taoist Tai Chi Society of Canada or the Fung Loy Kok Institute of Taoism through their respective accreditation programs.

SignatureDate

All registrations are subject to acceptance by the International Taoist Tai Chi Centre and subject to Ontario law.