Social Tai Chi Sign Up & Indemnity Form
Thank you for your interest in Social Tai Chi. Classes are twice a week, Monday’s and Wednesday’s from 19:00 - 20:00 at Bosch X Studio, 44 Belvedere Road, Rondebosch.

Please complete this Sign Up and Indemnity Form.

Training Fees:
R80 for a drop in class
R500 monthly or
R300 for 4 sessions
R600 for 8 sessions

Payment can be made to:
Rafeeqah Galant
Bank: FNB
B/Code: 250655
Acc/No: 62320495585
Ref: Your name

Or cash on the day. Please note there are no card facilities available. Please send me your proof of payment to taichi@rafeeqah.com, you will get a reminder when your fees need to be repaid.

Please wear loose fitting clothing and we will train barefoot, I look forward to seeing you in class! Please do not hesitate to message and ask any questions on 082 969 6359.
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Email *
Full Name
D.o.B
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Cell Number
How did you hear about us?
1. Do you have a family history (parent or siblings) of heart of metabolic disease?
2. Have you ever suffered from any heart, respiratory or metabolic condition?
3. Do you currently experience any symptoms of respiratory or cardiovascular disease?
4. Do you currently experience any general medical symptoms?
5. Do you currently suffer from any symptoms of joint injury or joint disease?
6.  Are you currently pregnant?
7. Are you a current smoker or have you smoked within the last 6 months?
8. Do you do less than 3 hours of physical activity per week?
Comments and/or questions
Terms & Conditions
Terms and Conditions.

Thank you for investing in Social Tai Chi; we appreciate your focus and dedication to achieving your goals and look forward to a great training relationship. Please take note of the following terms and conditions that will create the foundation and guidelines for your training time with us. Health Concerns. Prior to, or during the course of your training, health concerns may arise that need further input from your doctor, physiotherapist or other allied health professionals. Your trainer may request your assistance in obtaining that information. If a particular exercise is uncomfortable or painful for you to do or you have an injury, you may stop. Please ensure you have sufficient water during the training sessions.

No Liability / Indemnity

By ticking this registration form, you have volunteered to participate in a program of physical exercise under the direction of Social Tai Chi and/or its’ staff and/or its Instructors which will include, but may not be limited to, weight and/or resistance training. In consideration with Social Tai Chi's agreement to instruct, assist, and train you, you hereby and forever release and discharge and hold harmless Social Tai Chi and/or its’ Instructors from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with your participation in this or any exercise program, including any injuries resulting therefrom. You understand and are aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. You also understand that fitness activities involve a risk of injury and even death, and that you are voluntarily participating in these activities and using equipment with knowledge of the dangers involved. You hereby agree to expressly assume and accept any and all risks of injury or death. You further declare that you are physically sound and suffering from no condition that would prevent you from participation or use of equipment. You acknowledge that you have either had a physical examination and have been given Doctors permission to participate, or that you have decided to participate in activity and use equipment without the approval of your Doctor and do hereby assume all responsibility for your participation and activities, and utilisation of equipment in your activities. You are also aware that Social Tai Chi may record workouts for later use on television segments, websites, promotional materials or in any other way they see fit. By signing acceptance of these terms and conditions, you hereby authorize Social Tai Chi to use your name and likeness, voice, verbal statements, video-taped pictures for any of the aforementioned purposes. Right of admission is reserved to Social Tai Chi and Bosch X Studios.

YOU ACKNOWLEDGE THAT YOU HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY TICKING ACCEPTANCE OF THIS INDEMNITY / HEALTH SCREENING FORMS, YOU ARE WAIVING ANY RIGHT YOUR SUCCESSORS OR YOU MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST SOCIAL TAI CHI AND/OR ANY OF ITS STAFF AND/OR INSTRUCTORS.
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