Roxboro Community Center * Montreal * Tai Chi * Kung Fu * Summer Day Camps

                                            Statement of Release of Liability and Waiver

I, the undersigned, knowingly and without duress do voluntarily decide to attend any , some or

all of the below-mentioned seminars dates :

-Choy Lee Fut Seminar May 29 to June 6, 2010

I so hereby assume all risk of personal, physical or mental disabilities, injuries or losses which may result from participating in any, some or all of the above-mentioned events, and acting for myself, my heirs, personal representatives and assignees. I hereby release Master Chen Yong Fa, Sifu Jose Fernandez, Sergio Arione, Roxboro Community Center, their officers, agents, representatives, servants, employees, and all other related members from all claims, actions, suits controversies, claims at law or in equity by reason of any matter, cause or thingswhatsoever, that may hereafter sustain.

I also understand that there is risk of injury in all training and I assume full responsibilty for all my actions, during and in connection with said seminar dates or practises.

I fully understand that any medical treatment given to me will be of the first-aid type only, and I consent to such emergency treatment if deemed necessary. If required 911 emergency services will be called in for my assistance.

It is also noted and understood that the Roxboro Community Center and its instructors are unable to determine how far each participant should stretch or turn his/her body. The participant will have to monitor his/her movement within his/her own flexibility and capacity.

The participants will hold the Center and their instructors harmless and not liable in case of injury or damages originated from health problems or wrongful practises.

I further consent that any photos furnished by me, or any phots/videos taken of me in connection with the above mentioned events / dates can be used for publicity , promotions, or telelvison, and I waive all compensation in regards thereof.

Name of Participant (Please print)____________________________________

_____________________________                      ____________________________

Signature or Guardian if under age 16                                                  Date

  (if you have read this and signed your registration form stating you have read it on the website there is no need to print and attach to registration form as your signature will suffice as submitted with registration form.)

                    Roxboro Community Center www.taichimontreal..com