QIGONG • Yin-Yang Class

No casual class attendance is available, however you are welcome to join a class at any time during the term. The Term Fee will be adjusted accordingly. Please Register and Shirsha will be in touch with you shortly.

First Name *

Last Name *

Age *

Phone *

Email *

Address *

City *

State *

Postcode *

Please list any injuries, illnesses, medical conditions, allergies or anything else you think we should know about in the interests of your safety and well-being, and to ensure you receive the best care *

Are you taking prescribed drugs which may impair reaction time or judgement? If yes, please describe. *

What physical and/or mental health benefits would you like from this training? *

Please note: Instruction in Tai Chi, Qigong or Qi Power is not a replacement for medical advice, diagnosis or treatment of health conditions. If you have an acute or chronic ailment please seek medical attention from a qualified doctor.

Some exercises may not be suitable for everyone. If you are unsure about the suitability of Tai Chi, Qigong or Qi Power for you please contact Shirsha. If you have any injuries or medical conditions that you think may affect your ability to participate, please consult with your medical practitioner first.

Where did you find out about us? * Word of mouth
Internet Search
Magazine Advertisement
Facebook
Instagram
Other

DECLARATION OF UNDERSTANDING

I have read and understood the contents of this Application Form / Health Declaration.
I have read and accept the Terms & Conditions.
(This link to T&Cs opens in a new tab/window. After reading you can close that window and you will return here to complete the form)

I Accept *

If you experience any difficulties submitting this form, or you do not receive a reply:
please send us an email.

You can make your payment by Bank Transfer, please select below