Tai Chi at the Schmieding Center Tai Chi at the Schmieding Center Signed Agreement is required for participation * By signature below, I agree to the Schmieding Center’s Release and Waiver of Liability Statement I have carefully read the Schmieding Center’s Release and Waiver of Liability Statement and understand it to be a release and waiver of all potential claims and causes of action for my injury or death or damage to my property that occurs while participating in programs offered by the UAMS Schmieding Center, either in-person or via technology, and it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act(s) or omission(s). Signature Required (do not leave blank) * Signature Date * Next First * First Last Last Email * Phone * Residence County * BentonWashingtonMadisonBaxterBooneCarrollIzardMarionNewtonSearcyStoneother Gender * MaleFemaleOther Race * African-AmericanAmerican IndianAsian/Pacific IslanderCaucasianHispanicMiddle EasternOther Next First First Last Last Emergency Contact’s Phone Number In case of emergency, direct assistance to my location below. This is the address from which I plan to normally participate in this program. Fill-in Pre-Survey that follows to Complete Your Registration
