GRAND MASTER XIAO

MARTIAL ARTS AND SPORTS FITNESS CLUB

APPLICATION FORM

1310 S.W. MARINE DR. VANCOUVER, BC V6P5Z6

E-mail:

Website: www.wushumartialarts.com

Tel: 604-230-6372

Name
姓名 / Wushu Canada Member Yes No
加拿大武術協會會員 是 否
Gender Male Female
性别 男 女 / Birthday(mm/dd/yy)
出生日期
Address
地址
Email
電子郵件 / Home Phone
住宅電話
Work Phone
工作電話 / Cell Phone
手機電話
Emergency Contact
緊急聯絡
( Name & Phone Number )
（聯絡人及聯絡電話） / How do you find us?
你是怎麼知道我們的？
Online Referred Poster E-Mail
網絡 介紹 廣告畫 电子邮件
Terms and Conditions
I enter into this Agreement with Grand Master Xiao Martial Arts And Sports Fitness Club. ( Hereafter referred to as the Company ) and do hereby agree, on behalf of myself, my children, and all persons who become entitled to use the facilities of the Company by virtue of my membership, as follows:
Waiver and Release
I and my child(ren) fully recognize the risks of injury inherent in participating in any fitness or martial arts program, and we represent to the Company that we have taken all reasonable steps to determine, and hereby warrant, that we are in good health and physically capable of participating in the programs and courses of instruction offered by the Company. We acknowledge that the Company shall make no, and shall have no responsibility to make, any independent evaluation of our physical health or fitness.
We understand and agree that all participation in any such fitness program or use of the Company’s facilities or equipment on or off the premises of the Company shall be at our own risk. We hereby release, indemnify, and hold harmless the Company and its officers, directors, employees and agents, from and against any and all claims, demands, damages, costs and liabilities of any kind or nature to myself or my child(ren), or of any person or persons who become entitled to use the facilities of the Company by virtue of our membership.
We understand and agree that the Company shall not be responsible for the conduct of other users of the Company or its facilities or equipment, or participants in the Company’s off-premises programs, or for any injury or damage to property resulting from such conduct, and we shall not bring any action or proceeding against the Company for any payment compensation or claim for any injury caused by any such user.
Signature______Date ______
(Parent/guardian signature for students under 18 years of age )
Class / Frequency / Tuition1 / Total
·  Wushu
·  Tai Ji
·  Qi Gong
·  Qin Na
·  Self Defense / Once a week / ·  Monthly $65
·  Semi-Annually $351 ( 10% off )
·  Annually $624 ( 20% off )
Unlimited2 / ·  Monthly $130
·  Semi-Annually $702 ( 10% off )
·  Annually $1248( 20% off )
Total

1.  There is 10% off if tuition is paid semi-annually. There is 20% off if tuition is paid annually. The tuition fee is set by monthly not by actually attend times. If you miss a class, please make it up yourself.

2.  Unlimited frequency applies only for the same class type.