I, the undersigned, knowingly, voluntarily, and without duress, submit this form to TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch to participate in any class(es) or seminar(s) at TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch.  By signing and submitting this form, I assume all risk of personal physical or mental injuries, losses, or disabilities from whatever source sustained while attending said class(es) or seminar(s), and release and relinquish all claims, controversies, actions, suits, claims at law or in equity against the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch and their officers, employees, agents, servants, and all other persons acting on their behalf while attending said class(es) or seminar(s) and in route thereto and there from.  I understand that, in the event the class(es) or seminar(s) are cancelled, I will not hold the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch responsible for any losses that I may incur in seeking to attend said class(es) or seminar(s).  I understand that there is risk of injury in all martial arts training, and I assume full responsibility for all my actions, during and in connection with the class(es) or seminar(s).  I fully understand that any medical treatment given to me will be for first-aid only, and I consent to such emergency treatment or other emergency treatment deemed necessary and release the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch and their officers, employees, agents, servants, and all other persons acting on their behalf from any claim arising from such treatment. I further consent to having photographs, audio tapes and/or videotape taken of me by the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch in connection with any class (es) or seminar(s) and consent to the use by the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch of said photographs, audio tapes or videotape/ digital recordings for promotion, publicity, use on television, radio, home video, or in any other media, and I hereby waive all rights, claims, or compensation in regard thereto.  No photographs, audio tapes and/or videotape/ digital recordings may be taken of the seminar programs without the express consent of the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch.  Agreements must be made with the TAICHIUSA, Andy Lee’s Tai Chi Chuan Center of NJ and Yang Chengfu Tai Chi Chuan Center--USA, NJ Branch for any commercial venture.

This Statement of Release shall bind me, my heirs, my personal representatives, assignees, subrogates, third party beneficiaries, and any other persons with any claim or right arising from my participation in said class(es) or seminar(s).