BREATH AND BALANCE TAI CHI
Winter/ Spring 2008 Registration Form

 Name_______________________________________________
Address_____________________________________________
City______________________ State__________ Zip_________
Telephone Number: Home___________ Cell___________ Work_______________
E-mail_______________________________________________

Check the classes for which you are registering:

January 15 – May 9
____Tai Chi Fundamentals Tuesday 10:45 AM
____Tai Chi Fundamentals Thursday 5.00 PM
____Tai Chi Fundamentals Tues & Thur 10:45AM
____Yang Tai Chi Tuesday 12:00 PM
____Yang Tai Chi Tues & Fri 12:00 PM

FEES
____$144 TAI CHI FUNDAMENTALS: Once a week
____$272 TAI CHI FUNDAMENTALS: Twice a week
____$144 YANG TAI CHI: Once a week
____ $272 YANG TAI CHI: Twice a week
_______TOTAL PAID

Payment is due by the first class. Payment for the entire session is preferred; however please check with Lori if you need to arrange an alternative payment plan.

Please write check to Breath and Balance Tai Chi and mail to:

Lori Enloe 242 Highland Drive Iowa City, IA 52246

Phone Number: (319) 338-0005 E-mail: lori@breathbalance.com Website: www.breathbalance.com

**A minimum number of students are required to hold class. Please register early.

Liability Waiver and agreement (informed consent)

I acknowledge that it is my duty to exercise ordinary care for the protection of others and myself while attending Tai Chi class at Breathe and Balance Tai Chi. I assume the risk of physical activity with my own physical condition. I have received advice from my physician that I am capable of physical exercise such as provided by Lori Enloe or any substitute instructors, or I will seek advice, or I will assume the risk of exercising without a doctors examination. I take complete responsibility for my presence at Kahraman Dance Studio for Tai Chi class and I will not hold Lori Enloe or any substitutes responsible for any injuries or loss I may incur as a result of my participation in any Tai Chi class now or in the future.
Signature__________________________________ Date__________________
Print name _________________________________
Parent/guardian if under 18_____________________________________________

REFUND POLICY

No refund after the first week of classes.
A $10.00 administrative fee plus a $10 single class fee will be deducted from your refund.
Lori Enloe may be contacted at 319-338-0005 or lori@breathbalance.com
Lori is also available to give presentations and private day time lessons (individual or group)