Major Illnesses Declaration Form
I, the Applicant, am applying to join the Association as a Term Member and I voluntarily agree to participate in all workshops, trainings, group practices and activities which may be organized and/or conducted by the Association.
I understand that the regimen taught by the Association is a very safe health preservation exercise which can improve the overall health of most people. However, if I have any disease, whether real, potential, unknown or otherwise, I will always be exposed to potential risks when performing and/or adopting any exercise regimen and/or health care methods.
I fully know and understand that, I may not be able to participate in any of the workshops, training courses, group practices and activities which may be organized and/or conducted by the Association if I have sought medical advices or was treated in the past for or is currently being treated or is suffering from any of the following illnesses and/or conditions:
- Myocardial infarction 心肌梗塞;
- Cardiac catheterization 心导管手术;
- Pacemaker 心脏起搏器;
- Angina pectoris 狭心症,
- Myocardial hypertrophy 心肌肥厚;
- Endocarditis 心内膜炎;
- Rheumatic heart disease 风湿性心脏病；
- Congenital heart disease 先天性心脏病;
- Aortic aneurysm 主动脉血管瘤;
- Cerebral Stroke (cerebral hemorrhage, cerebral embolism) 腦中風(腦出血,腦梗塞）;
- Cerebral tumor 脑瘤;
- Cerebral artery hemangioma 脑动脉血管瘤;
- Cerebral arteriosclerosis 腦動脈硬化症;
- Epilepsy 癫痫;
- Parkinson’s disease 巴金森氏症;
- Psychosis 精神疾病;
- Retinal detachment 视眼膜剝离或出血;
- Pulmonary emphysema 肺氣腫;
- Bronchiectasis 支气管擴张症;
- Pulmonary tuberculosis 肺结核;
- Pulmonary embolism 肺栓塞;
- AIDS or HIV carrier 艾滋病;
- Had surgery less than one month ago 手术不满一个月;
- Artificial joint 人工关节;
- Pancreatitis 胰臟炎。
- Attended other classes or has deviated from the correct method 因學其他學習班或者學習方法走偏者;
- Major surgical history 重大手術史;
- Pregnancy 懷孕;
I confirm that I have made full and frank disclosures of my health conditions to the Association prior to my application to join the same. I understand that I have an ongoing responsibility to make full and frank disclosures of my health conditions to the Association throughout my membership term and if I do not truthfully and honestly make such disclosures to the Association herein and during my membership term, I shall assume all risks, take full responsibility and accountability for my safety, health conditions and life in respect of my participation in all of the workshops, trainings, group practices and activities which may be organized and/or conducted by the Association in the event of death, any future or current discomforts, accidents, incidents, losses, damages or injuries whatsoever which may arise due to my health conditions and/or any omission on my part to declare the same and I agree that I shall waive, withdraw, renounce, and/or disclaim all claims, requests, demands whatsoever against the Association and/or its’ personnel including but not limited to any on-site attendants, staff, helpers, volunteers whatsoever in all circumstances irrespective of how from caused and whether or not they are caused by the personnel’s mistakes or negligence.
I hereby confirm that I have read, understand and agree to all of the above terms.