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By submitting this form, I declare:

I understand that this form acts as my reservation of attendance to this workshop, and that this form holds my spot in this class. In the event that I cannot attend the workshop, I must notify Restita DeJesus before the date of the event. I agree to remit the workshop fee of $65 on the day of the workshop, in good funds, in the form of Cash, Check, Money Order, or Cashier's Check. I understand that I may choose to remit my tuition by credit card via PayPal, but that the tuition will be an additional $3.00 for the credit transaction/convenience fee. Should I opt to use my credit or debit card, I understand I will notify Restita DeJesus well before the event, request a PayPal invoice for the total amount (which will be sent to me within 24 hours), and remit payment before the date of the event.

I understand that this 6 healing sounds workshop is open to individuals ages 14 and older. People under 14 years old are allowed only by express permission from Restita DeJesus. Very young children (under 10 years old) are NOT allowed at this event, as much of the workshop is very academic and young children may not understand the material.

I understand that although Qigong is a safe exercise, I will not hold Seattle Wushu Center, Restita DeJesus, the facility's owners and agents, liable for damages, losses or injuries sustained if such injuries or losses are a result of: 1) non compliance with safety rules and regulations as set forth by Restita DeJesus during the workshop, 2) ignorance of instructions of practice, or 3) my choices of activities during rest breaks or lunch breaks.

I understand that Qigong is an alternative practice that should NOT replace conventional medicine, and that I will rely on my primary medical doctor's advice. I understand that if I am currently undergoing medical treatments (chemotherapy, dialysis, physical therapy, etc) or taking medications for health conditions, that I shall keep with the regimen as directed by my primary doctor. I understand that Ms. Restita DeJesus does not guarantee or imply that Qigong or any other alternative health practice will "cure" or "stop" any disease or condition. I understand that Restita is NOT certified as a medical Doctor, nurse practitioner, physical therapist therefore Ms. DeJesus cannot give medical advice, diagnosis, nor can she prescribe internal medications. Ms. DeJesus CAN, however, suggest that you consult your medical professionals about such questions or concerns, give Qigong movements or breathing methods you may practice on your own, or give advice on other modalities within her expertise (Tai Chi, Reiki, meridian activation/cleansing, crystals, and Filipino energy methods).

By clicking "yes" below, I declare that I have read this statement and agree with all contained therein, and that it acts as my signature and permission for myself and/or my children to attend this event.





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