Pat Rice

Director and Instructor

Owen Sargent

Shenandoah Wushu
Coach


CHINESE EXERCISE AND HEALTH CLASSES
For Adults, Teens, and Children

A Yang Chengfu Center of the International
Yang Family Tai Chi Chuan Association

706 S. Loudoun St.
Winchester, VA 22601
School Phone:
540-247-2283
Home/Office:
540-667-7595

atocrice@shentaijiwushu.com


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Registration Form Page

The form below is used for online Class and Seminar registration for the "Shenandoah Taijiquan Center", and may be either submitted securely online for Registration and Payment or Printed and submitted by Snail Mail by simply filling out the form and clicking the Print button at the bottom of the page. If submitting your registration by mail, please make your check or money order in U.S. Dollars only, payable to:

Attn: Registrations
Shenandoah Taijiquan Center
706 S. Loudoun St.
Winchester, VA 22601

First Name:    Middle Initial    Last Name:

Street Address or P.O. Box:

City:    State:    Zip Code:

Country, if outside U.S.:

Email Address:

Home Telephone: (Ex.: 555-555-5555)

Work Telephone:

Date of Birth: (Ex.: November 8, 1977)


RELEASE/AGREEMENT and PAYMENT POLICIES

Release

I understand that all exercises and programs are undertaken at my own risk. I understand the procedures and exercises involved in instruction and participation as explained to me by a representative of the Center. I have been furnished with a copy of the written rules for free sparring/free fighting. I understand that there is a risk of personal injury involved in the course of instruction and with this knowledge agree to indemnify and hold harmless the property owner and its lessee, the company and the officers of the company operating the Center, the Center, the Center's employees, and the program instructor(s) from all losses caused by accident or injury to myself or to third persons, who may be enrollees of the Center, in the event that either I or said third person is injured in any way during the performance and execution of exercises. The property owner and its lessee, the company and the officers of the company operating the Center, the Center, the Center's employees, and the program instructor(s) shall not be responsible for damaged, lost, or stolen property inside or outside the facility.

Agreement to Payment Policies

  1. Contracts are not required. Students may withdraw from a program or course at any time without further financial obligation.
  2. Registration fee is non-refundable.
  3. Tuition is due at the first class attendance for each course. Monthly tuition is due on the first of each month.
  4. Course enrollment fees are not refundable after the student has attended a second class and are not transferable, and no extensions or refunds for missed classes.

Signature of student:

          **This "electronic" Signature of parent or guardian is required if student is under age 18.

School Classes-
Enrollment Information and Payment:

Registration Fee (a one-time fee/includes FREE school T-shirt): $25


Taijiquan, More info...

FOUNDATION COURSES (prerequisites for "STANDARD CLASSES" below):

   Course 1: Introduction to Taijiquan, 8 Week Course/Once a Week, $110

   Course 2: Introduction to Taijiquan, 8 Week Course/Once a Week, $110

STANDARD CLASSES:

   Traditional Yang Family Style Taijiquan: Hand Form, 8 Week Course/Twice a Week, $190

   Traditional Yang Family Style Taijiquan: Hand Form, 8 Week Course/Once a Week, $160

   Intermediate Studies in Taijiquan: Weapons Forms, 8 Week Course/Once a Week, $160

   Intermediate Studies in Taijiquan: Push-Hands, 8 Week Course/Once a Week, $160

   Advanced Studies in Taijiquan: Selected Topics, Price To Be Arranged, Email Us


Wushu, More info...

   Wushu, Youth Level One, Twice a Week, $75

   Wushu, Youth Level One, Once a Week, $50

   Wushu, Adults Level Two, Twice a Week, $75

   Wushu, Adults Level Two, Once a Week, $50


Qigong, More info...

   Mindful Movement through Tai Chi and Qigong, Flex Card (8 Classes), $135

   Mindful Movement through Tai Chi and Qigong, Drop In Single Class, $20

   Special Workshop, Price To Be Arranged, Email Us


CREDIT CARD PAYMENT

(ALL FIELDS ARE REQUIRED)

Card Type: Visa, Mastercard Discover

Card Number (No spaces or dashes):

3-digit Security Code:

**On the back of your card, to the  right of your card number - 3 digits

Card Expiration Date:   Month    Year

$ Amount to be Charged

**Total of what you've checked above.

Name, as it appears on card:

Billing Street Address or P.O. Box:

City:  State:  Zip Code:

Country, if outside U.S.






Home  Taijiquan / Tai Chi Chuan  Wushu  Qigong  Other Studies  Registration

Activities and Events Calendar, 2013  Faculty and Staff  A Taste of China website

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