Reservation Form

FUNG LOY KOK INSTITUTE OF TAOISM For Office Use Only INTERNATIONAL TAOIST TAI CHI CENTRE Charitable Organization (# 11893 4371 RR0001) Res# Room No. 248305 5th Sideroad, RR#5, Orangeville, Ontario, L9W 2Z2 Tel: 519-941-5981 Fax: 519-941-4542 E-mail: [email protected] Website: www.taoist.org

RESERVATION FORM

Personal Information Original Reservation Revised Reservation First Name Last Name Birthdate (mm/dd/yyyy) Male Female Mailing Address Same as previous reservation City

Province/State Country Postal/Zip Code

E-mail Address Primary Phone Home Work Cell Secondary Phone Home Work Cell

Emergency Contact Name Emergency Contact Telephone Number Relationship of Emergency Contact

Instructor Branch Region Beginner Continuing Not an Instructor

Purpose of Reservation Workshop/Event Name(s) Workshop/Event Dates (mm/dd/yyyy) Volunteering – Start Date (mm/dd/yyyy) 1. to 2. to End Date (mm/dd/yyyy)

Arrival and Departure Travel Mode Arrival: Date Time Departure: Date Time mm/dd/yyyy h:mm am/pm mm/dd/yyyy h:mm am/pm OWN CAR

Other (explain): Airline: Airline: AIRPORT Please wait OUTSIDE at the arrivals level Terminal 1 – Area F or Terminal 3 – Post #2 Flight#: Flight#:

UNION TRAIN STATION Please wait across the road on the Souh West Corner of Front and York street. Train#: Train#:

TORONTO BUS DEPOT - Please wait at the corner of Elizabeth Street and Edward Street. Bus#: Bus#: Pick Up Drop Off Request I would like to be picked up I would like to be dropped off Please call our toll free numbers at 1-877-585-8822(TTCC) after you have retrieved your luggage, to confirm your arrival. Help us find you – display a visible Tai Chi logo and watch vigilantly for our marked FLK- Taoist Tai Chi™ vehicle. Accommodation

Bed on the property Camping on the property RV or Motor Home None–Own accommodation elsewhere None-Staying for 1 day Special requirements due to health reasons (please explain): Beds are assigned according to need. We request that seniors and those with health concerns give two weeks’ notice in order to be given priority. Meals Regular Steamed plain food (nothing added) Vegetarian Vegetarian + Fish Please supplement your own special diet food if needed. Food Allergies:

Declaration I have carefully read both pages of this form, including the sections entitled Assumption of Risks, Release, Waiver and Indemnity, Teaching and Promotional Use of Photographs, and I agree with all of its terms and conditions.

Signature Date All registrations are subject to acceptance by the Fung Loy Kok Institute of Taoism and subject to Ontario law.

042a110d7f6c3acac545fbbd590bd79b.doc Page 1 of 2 FUNG LOY KOK INSTITUTE OF TAOISM INTERNATIONAL TAOIST TAI CHI CENTRE Charitable Organization (# 11893 4371 RR0001) 248305 5th Sideroad, RR#5, Orangeville, Ontario, L9W 2Z2 Tel: 519-941-5981 Fax: 519-941-4542 E-mail: [email protected] Website: www.taoist.org

RESERVATION FORM

Assumption of Risks I, the named applicant, acknowledge that risks of injury associated with body movement depend in large part on my state of fitness, my state of mental, physical and emotional health and the degree of care and competence that I apply when I participate in such activity. By choosing to participate in programs and activities of Fung Loy Kok Institute of Taoism (FLK), I accept and assume all risks associated with such programs and activities and the possibility of personal injury, death, property damage and loss resulting therefrom, due to any cause whatsoever, including negligence on the part of FLK or any of the other Releasees (as defined below). I agree that I am solely responsible for determining that I am medically able to participate in FLK programs and activities. I acknowledge that FLK and the other Releasees assume no such risks or responsibility. I agree that I am free to interrupt, reduce or modify my participation and that I should do so if I experience any adverse symptom. In case of doubt, it is my responsibility to consult an appropriate professional.

Release, Waiver and Indemnity In consideration of acceptance of my registration in any of FLK’s programs and activities (which include the Taoist Tai Chi™ internal arts), I, the named applicant, hereby: 1) WAIVE ANY AND ALL CLAIMS that I have, or may in the future have, against FLK and its directors, officers, members, employees, instructors, agents, representatives, volunteers, successors and assigns (collectively, the “Releasees”) and RELEASE AND DISCHARGE THE RELEASEES from any and all liability for any loss, damage, or injury that I may suffer, including, but not limited to, personal injury, death, loss of or damage to my property or property in my possession, resulting from my presence at or use of FLK’s premises and/or my participation in any of FLK’s programs and activities, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory or other duty of care on the part of the Releasees; and 2) agree to INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any and all claims or demands which may be made against the Releasees, and any and all loss, liability, damage or costs the Releasees may incur, arising out of or in consequence of my presence at or use of FLK’s premises and/or my participation in any of FLK’s programs and activities.

I represent and warrant that I am at least of the age of majority in the province in which I reside. I agree that this release, waiver and indemnity is intended to be as broad and inclusive as is permitted by applicable law and that if any portion is held invalid, the balance shall, notwithstanding, continue in full legal force and effect. I agree that this release, waiver and indemnity shall be binding on my heirs, next of kin, executors, administrators, assigns and personal representatives. This agreement shall be governed by and interpreted in accordance with the laws of the province of Ontario.

Teaching I agree that, as a condition of my registration, I am not authorized to engage in teaching any of the Taoist Tai Chi™ internal arts taught by FLK without the express consent of FLK.

Taoist Tai Chi™ internal arts include namely the 108 move set, Taoist sword and Taoist sabre forms, Lok Hup Ba Fa, Hsing-i, Taoist foundation exercises, Taoist meditation, Taoist chanting and ceremonies, all as taught and practiced by FLK.

I am aware that the “Fung Loy Kok Institute of Taoism” and “Taoist Tai Chi” logos and the expressions “Fung Loy Kok Institute of Taoism” and “Taoist Tai Chi” are trademarks (certification marks) of Certmark Holdings Co. ltd., which certify the genuine and unbroken transmission of Master Moy Lin-shin’s teachings through the organizations he originated. I agree that my participation in FLK activities does not give me any right to use these marks without the FLK’s express consent.

Promotional Use of Photographs I consent and allow FLK to use my picture or any photographs taken by me for any promotional materials including the website and any related website links as may be required from time to time for its purposes.

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