Tai Chi

chiGet Active Now
Tai Chi Classes are offered at RELC during three, 12-weeks sessions per year. You may join in at any time! Get active. Studies show the more active you are – the healthier! 

Days/Times/Dates
Monday & Wednesday’s at 9:00-10:00 a.m.
Current session runs from September 14 – December 2, 2015

To participate call organizers Nicki Ayer 402-660-5352 or Karen Hitz at 402-212-2589.
phone

 


Sign up online

In participating in this program you will be waiving and releasing all claims arising out of the Tai Chi for Balance, Tai Chi: Moving for Better Balance (TCB, TCMBB) Program. In consideration of you providing the TCB, TCMBB Program and accepting me as a participant,

You, Agree as follows:

I am fully informed of the details of the TCB, TCMBB Program and have received satisfactory answers to all questions I have concerning the TCB, TCMBB Program. I do hereby assume the full risk of any injuries and all costs, damages, and losses that I may sustain as a result of participating in any and all activities connected with or associated with the TCB, TCMBB Program.

I grant Tai Chi for Balance the right to record, broadcast, and otherwise use in any media my performance in the TCB, TCMBB Program and to use my name, likeness, voice, and biographical information concerning the TCB, TCMBB Program.

I assume all risks associated with my participation in the TCB, TCMBB Program and release, indemnify and hold harmless certified instructor [text instructor], and their respective directors, officers, employees, agents, successors, and assigns, from and against any and all claims, damages, liabilities, and expenses arising from my participation in the TCB, TCMBB Program. I have read and fully understand the foregoing terms.

Signature of Participant:

Date (xx/xx/xxxx) :


HEALTH HISTORY

Class Location

Full Name

Birth Date (xx/xx/xxxx):

Sex M/F:

Healthcare Provider:

Address:

City:

State:

Zip:

Home Phone:

Your Email

Emergency Contact:

Their Phone:

For most people, physical activity should not pose any problem or health hazard. This health history has been designed to identify the adults for whom physical activity might be inappropriate or for those who should have medical advice concerning the type of activity most suitable for them.

Please read the questions carefully and answer the question as it applies to you.

Has your doctor ever said you have heart disease (Y/N)? YesNo

Has your doctor ever said your blood pressure was high (Y/N)? YesNo

Do you frequently have chest pains (Y/N)? YesNo

Do you frequently have back or joint pain (Y/N)? YesNo

If yes, which joints?

Do you often feel faint or have spells of severe dizziness (Y/N)?YesNo

Do you have osteoporosis (Y/N)? YesNo

Do you have arthritis (Y/N)? YesNo

If yes, please list the affected joints:

Do you use medications on a regular basis (Y/N)? YesNo

If yes, please list these medications:

Have you fallen in the last 6 months (Y/N)? YesNo

Do you have any other physical condition that would keep you from safely

participating in this program (Y/N)? YesNo

Have you told your doctor that you are participating in this program (Y/N)? YesNo

If you answered yes to ANY of questions 1-10 you should consult your physician before participating in an exercise class.

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