Waiver

Please read each section carefully, then complete and submit the form.

RVA Bagua Questionnaire, Rules, and Waiver

Personal Information

First Name

Please provide a valid first name

Last Name

Please provide a valid last name

Date of Birth

Please provide a valid date of birth

Guardian Name (if under 18 years of age)

Please provide a valid guardian name

Street Address

Please provide a valid street address

City

Please provide a valid city

State

Please provide a valid state

Zipcode

Please provide a valid zipcode

Please provide a valid email

Phone

Please provide a valid phone number

Emergency Contact Name

Emergency Contact Phone

Experience

Previous experience in martial or health-oriented arts

Medical Information

Please check any of the below conditions that may apply to you:

I have a medical condition that may make physical exercise dangerous for me

I have a heart condition or family history of heart disease

I have suffered a stroke

I have unexplained pains in my chest at rest or during physical activity

I have dizziness during physical exercise

I have asthma and/or require use of an inhaler

I have Type I or Type II Diabetes

I have high blood pressure

I have high cholesterol

I have high blood sugar

I am pregnant or have given birth in the last 12 months

I take one or more prescription medications

If yes, please list your prescriptions here

Please list any other allergic reactions, physical, or medical limitations we should be aware of

I agree the above medical information is truthful and completed to the best of my ability.

You must agree to complete this form

School Rules

The rules, guidelines, and etiquette outlined below are to ensure that students learn, have fun, and are safe. They also are meant to help provide a general behavioral standard for students to which they should adhere. Thus, they are written in accord with the principles of the Qiang Shan Ba Gua Zhang Motto: Wisdom, Benevolence, Sincerity, Bravery.

Bow when entering and leaving the floor of the school. It is also important to salute your instructor when you address him. This is to show respect and modesty.
During class, do not enter or leave the class without informing your instructor. Inform the instructor prior to beginning the class if you have to leave early and the Instructor will inform you if you are going to be allowed to take that particular class. Some classes cannot be interrupted. It is not conducive to a good learning experience to interrupt a class.
Students must refer to the instructors as Shifu, Sir, or Ma’am.
All students must treat each other with respect. No one can learn a martial art to any degree of proficiency without a training partner. So be respectful.
All students are expected to be courteous and understanding to one another and to the Instructor.
Advanced students are expected to set good examples to new students, and to assist such students whenever necessary. We are all learning together.
No horse play, loud conversations or excessive laughing during class.
For safety reasons, students are not allowed to chew gum during class.
For safety reasons, students must remove all jewelry during class.
For safety reasons, all fingernails must be clipped.
Students’ uniforms must be clean at all times.
Students must be in complete uniform at all times.
Any substitute teacher shall be treated as your regular instructor.
Do not use any of the techniques learned at this school except to protect the well being of oneself or the defenseless.
Do not teach techniques or moves to individuals outside of this school.
Do not engage in any activity that might degrade the code of martial arts ethics or the reputation of this school. Do not get into fights and do not bully others.
You must have the approval from the school/organization before participating in any tournaments.
Do not participate in any other martial arts school while enrolled in this school. Learning multiple arts will demand too much of your mind and body and will not create the proper techniques and reflexes.
Hands off of weapons that do not belong to you. Hands off of weapons unless otherwise instructed.
All students are to help pick up equipment after class.

I agree the above school rules.

You must agree to complete this form

Waiver/Release Of Liability

I hereby acknowledge that I have voluntarily chosen to participate in the martial arts classes organized by RVA Bagua. I understand that participating in martial arts activities involves inherent risks, including but not limited to physical injury, disability, and even death. In consideration for being allowed to participate in the martial arts classes, I agree to the following terms and conditions:

Assumption of Risk: I acknowledge that I have been informed and understand the nature of the activities involved in the martial arts classes. I am aware that practicing martial arts can be physically demanding and that injuries may occur. I voluntarily assume all risks associated with my participation in the classes, including any risks that may arise from the actions or negligence of others.
Medical Condition: I certify that I am physically and mentally capable of participating in the martial arts classes. I do not have any medical conditions, disabilities, or injuries that would prevent or limit my involvement. If there are any changes to my medical condition before or during the classes, I agree to inform the RVA Bagua instructors immediately.
Release and Waiver: I hereby release, waive, discharge, and covenant not to sue RVA Bagua, its instructors, employees, volunteers, and any other associated personnel, from any and all claims, liabilities, actions, demands, expenses, or damages arising out of my participation in the martial arts classes, including but not limited to personal injury, property damage, or wrongful death.
Indemnification: I agree to indemnify and hold harmless RVA Bagua, its instructors, employees, volunteers, and any other associated personnel, from any and all claims, liabilities, actions, demands, expenses, or damages arising out of my participation in the martial arts classes, including but not limited to personal injury, property damage, or wrongful death.
Photographic Release: I grant RVA Bagua permission to use any photographs, videos, or other media taken during the martial arts classes, which may include my likeness, for promotional and educational purposes without compensation or further notice.
Governing Law and Jurisdiction: This waiver and release of liability shall be governed by and construed in accordance with the laws of Virginia, United States of America. Any legal action or proceeding arising out of or relating to this waiver shall be brought in the courts of Virginia, United States of America, and I consent to the exclusive jurisdiction of such courts.

I have read this waiver and release of liability carefully, and I understand its contents. I am aware that by signing this document, I am waiving certain legal rights I may have against RVA Bagua.

I agree to the terms listed in Waiver/Release of Liability.

You must agree to complete this form

Signature

By typing in my name, I acknowledge my signature on the waiver.

Participant Signature

Please type your signature

Guardian Signature (If under 18 years of age)