Powered by Qi - Liability Waiver Form

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Powered by Qi Release and Waiver of Indemnity Agreement

We kindly ask you to review the document below carefully and complete the form in its entirety. This waiver is required for all participants wishing to engage in Powered by Qi classes, whether online or in person.

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Step 1: Participant Information

First name *

Last name *

Email *

Address *

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Assumption Of Risk, Consent & Liability

Acknowledgment and Assumption of Risk:
I acknowledge that participating in meditation, movement, martial arts, and other practices taught by Powered by Qi and Kelly Hong-Williams involves potential risks including physical injury and emotional stress. I voluntarily assume full responsibility for any loss, damage, or injury I may sustain while attending in-person or online classes or while using instructional videos. I further acknowledge that I have received no warranties or guarantees regarding the effectiveness of this training.

Medical Disclaimer:
I understand that Kelly Hong-Williams is not a medical doctor and her teachings do not replace professional medical advice. If I have any medical or psychological concerns, I will consult my healthcare provider before participating in training with her. I further acknowledge that if, at any time, it is determined that there are potential safety risks for me, my participation may be denied.

Online Classes: I understand that during live online sessions, Kelly Hong-Williams may be unable to see me due to technical issues or camera settings. Therefore, I agree to exercise caution and remain within my personal safety zone and participate at my own risk.

Release of Liability: I hereby release Kelly Hong-Williams, all associated Powered by Qi personnel, the Mission Seniors Centre Association, and the Yang Chengfu Tai Chi Center Seattle from any and all liability for any injuries or damages that may occur during seminars, instructor trainings, classes, or while using videos provided by Powered by Qi.

Acknowledgment of Rules and Procedures: I agree to comply with all rules established by Powered by Qi and Kelly Hong-Williams to maintain order and ensure student safety. This includes following all instructor directions and refraining from teaching or recording class materials without prior permission. I understand that violations may result in immediate dismissal from training without refund or compensation.

Copyright Notice: The names, materials, exercises, and components used in classes are protected by copyrights and trademarks owned by Powered by Qi and Kelly Hong-Williams. Reproduction without written permission is prohibited.

Consent to Record: I voluntarily grant permission to record, photograph, and/or capture my image, voice, and/or likeness, during instructional activities, including but not limited to classes, lessons, discussions, presentations, or projects.

Prior Permission Required for Use: I understand that no recordings or materials that include me will be used, shared, published, or distributed beyond the instructional setting without my prior, explicit permission.

Permission will be requested separately for each intended use, and I may choose to approve or decline without penalty.

No Compensation: I understand that if I grant permission for use, no compensation or royalties will be provided.

Voluntary Participation and Non-Impact: I understand that granting or refusing permission will not affect my standing or relationship with the instructor or institution.

I UNDERSTAND AND AGREE THAT THIS DOCUMENT CONSTITUTES:

An unqualified ASSUMPTION OF ALL RISKS associated with participation in this program including those arising from negligence.
A FULL AND FINAL RELEASE AND WAIVER OF LIABILITY in favour of Powered by Qi and all associated individuals for any injuries or damages sustained during participation.
An agreement NOT TO COMMENCE OR MAINTAIN ANY LEGAL ACTION AGAINST THE RELEASEES for losses related to participation in this program.
FULL PERMISSION for Powered by Qi to record and use "Materials" (photos/videos) related to my involvement WITHOUT COMPENSATION. No recordings or materials that include me will be used, shared, published or distributed WITHOUT MY PRIOR, EXPLICIT PERMISSION (or the permission of my parent/guardian if I am under 18).
An AGREEMENT TO INDEMNIFY AND HOLD HARMLESS the RELEASEES against any claims, demand, or actions brought arising from my participation, whether due to their negilgence or otherwise.

I HAVE READ THIS DOCUMENT THOROUGHLY AND UNDERSTAND THAT THE RELEASEES ARE RELYING UPON MY REPRESENTATIONS AND AGREEMENTS IN ACCEPTING MY PARTICIPATION IN THIS PROGRAM.

BY DIGITALLY ENTERING MY INFORMATION BELOW, I ACKNOWLEDGE THAT I AM SIGNING THIS DOCUMENT AND VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS.

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Step 3: Confirm Information *

Have you read the waiver in it's entirety, and do you agree to its terms?

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Step 4: Electronic signature*

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33195 Rose Avenue, Mission, BC, V2V4Z4 604-315-5946

www.poweredbyqi.com info@poweredbyqi.com