Form Center

2. Tai Chi for Arthritis and Fall Prevention is an evidence-based program recommended by the CDC for the improvement of overall wellness and fall prevention. This program will be led by a certified instructor from the Health and Wellness division of Liberty Parks & Rec. Classes are progressive in nature and weekly attendance is critical for a successful outcome.

    PROGRAM INFORMATION:

   Tai Chi for Arthritis and Fall Prevention 

   • Session Dates: June 5 - Oct 2 (16 classes)
   • Days: Thursday 
   • Time: 11:00 a.m.- 12:00 p.m.
   • Registration required
   • Registration deadline is June 3
   • Must be 60+
4. First Name*
5. Last Name*
7. Date of Birth*
   Date of Birth
9. Email Address*
11. Phone Number*
12. Phone type *

    1. Cell
    2. Home
14. Street Address*
16. City*
18. Zip Code*
20. Primary Race*

    1. African American
    2. American Indian or Alaskan Native
    3. Asian
    4. Middle Eastern
    5. Native Hawaiian or Pacific Islander
    6. Other
    7. White (Hispanic & Non-Hispanic)
22. Gender*

    1. Male
    2. Female
    3. Prefer not to share
24. Participation Waiver
    I am over the age of 18 and acknowledge I have been informed of the need for a physician’s approval for my participation in wellness programming. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this program, I acknowledge I am doing so at my own risk.
    
    I understand and am aware that health and wellness programming includes potentially risky activities. I am voluntarily participating in these activities with knowledge of the potential risks. I hereby agree to hold harmless Liberty Parks & Recreation, its respective representatives, executors, agents, and assigns from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected to my participation in any and all wellness programming.
    
    I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Liberty Parks & Recreation, its respective representatives, executors, and/or assigns.
    
    * I have read the above information and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
26. Acknowledgement*

    1. I Agree
Leave This Blank:


28. Submit

* indicates a required field