"课堂规则同意书" 與 "身体健康状况告知同意书"公告(英文版)Workshop Rules Consent Form & Health Condition Declaration Form - 白雁自主健康管理學 Skip to content

“课堂规则同意书” 與 “身体健康状况告知同意书”公告(英文版)Workshop Rules Consent Form & Health Condition Declaration Form

Workshop Rules Consent Form (课堂规则同意书)「課堂規則同意書」

 

Applicant’s name:

I, __________________, a Term Member of the Association, am applying to join and participate in the following workshops (please tick whichever applicable) and consent to the rules of the workshops herein contained:

o HarmonyQi;

o EnerQi Beginners;

o EnerQi Intermediate;

o EnerQi Advance;

o YoungQi Beginners;

o YoungQi Intermediate; and

o YoungQi Advance.

 

Article 1 Eligibility

I agree to adhere to all the workshops and class rules herein contained including but not limited to the following, should a violation thereof occur, the Association reserves the right of legal proceedings.

  1. Wearing my membership pass and the uniform of the Association before entering the workshop(s)’ classroom(s) and at all times therein;
  2. Not lending my membership pass to any other person and keeping my membership pass safely and in my possession at all times as I understand that the same is being referred to by the Association when allowing participants to participate in their workshops;
  3. Obtaining the consent of the Association and be registered in the designated list before entering the workshop(s) classroom(s) after the end of each training session;
  4. Paying the requisite fee to the Association for the replacement of my membership pass in the event of the same being stolen, lost, destroyed and/or damaged;
  5. Reporting the identity if my relatives and/or friends accompanying me to the workshops. I understand that they are not allowed to enter the workshop(s)’ classroom(s).
  6. Members without prior approval of the Association, or Members who are not included in the Training Programme, or Members whose eligibility do not meet the qualifying criteria for participation are not permitted to participate, attend and join in the Training Programme and related activities, including but not limited to group practices, revisions, enhancement and fine-tuning courses, seminars, workshops and dialogues, etc.

Article 2 Rights and Obligations

I have read all the relevant membership terms, member’s statement of rights and obligations (complete contents of which can be found in the membership application form, the other forms executed by me prior to my admission to the Association, the Association’s website and Constitution) and I hereby agree, acknowledge and undertake to adhere to all the relevant rules of the Association which are applicable to me from the said sources and from all the resolutions passed by the Association.

 

Article 3 Agreement on Authorship and Copyright

I agree to adhere to the rules of the Association on the authorship, copyright and intellectual property of the Association. I agree, acknowledge and understand that:

  1. Audio recordings, video recordings and photography, of the workshop(s) are strictly prohibited irrespective the location(s) and/or venue(s) of which they are held.  Without prior written consent of the Association, audio recording, video recording, and photography are not permitted. Once violation of these regulations is ascertained, the Association reserves the right to exercise its rights over legal prosecution. In addition to the punitive penalty of NTD10 million, the Association reserves the right to seek compensation and recourse for all damages suffered and incurred.
  2. The contents taught by the Association shall be under the protection of intellectual property patent rights, its registered contents include but are not limited to names and particulars of the workshop(s) trainings, contents of trainings and handouts, music for practices, etc.  Without the consent of the Association, Members are prohibited from transferring technique and content to others;
  3. I shall not disclose, distribute and/or teach any of the Association’s contents, materials and/or information to any other person without the consent of the Association.  Without the consent of the Association, Members are prohibited from transferring technique content to others;
  4. Members are prohibited from teaching, instructing, training, sharing, or conveying any technique content, whether in private or public, without the written permission of the Association. In the event of violation thereof, the Association reserves the right of legal proceedings regardless whether or not damage to reputation, and / or injury, harm, damage, deterioration of state of health, undesirable circumstances, etc.,  are involved.
  5. I shall fully indemnify and hold harmless the Association and/or its’ personnel from and against all claims, suits, demands, actions and/or proceedings that may be brought against the Association and/or its’ personnel and/or all losses, damages, expenses that may be incurred or suffered by the Association and/or its’ personnel in the event of any undesirable consequences caused by me to the Association as a result of any breach of my duty of non-disclosure herein contained.

 

Article 4 Health Conditions, Safety and Life

I fully declare and confirm that I am fully aware and understand the following:

  1. That during my participation in any of the workshops, trainings, activities or group practices as may be organized and/or conducted by the Association or otherwise irrespective of the location of which the same is being conducted or held at, in group, individually or otherwise (“My Participation”):i) I must at all times assess and monitor my own physical strengths, fitness, abilities and health conditions and not overexert and/or perform any improper techniques, exercises and/or physically exhausting activities and adhere to the guidance and instructions of the Association; andii) Immediately stop practice and forthwith seek medical attention and assistance in the event I experience and/or suffer any cold sweats, discomfort, pain, sprain, shortness of breath, palpitation, angina, headache, bleeding dizziness, vomiting, injury etc. or encounter any accidents and/or incidents including but not limited to falling or bruising.
  2. That the purpose of the qigong practice is to improve my overall health conditions but it shall not in any manner be a substitute to any of the medical treatments and/or medications that I am undergoing or shall undergo, taking or shall take and the proposed regime needs to be combined with my regular treatments (if any);
  3. That I shall not stop and/or reduce the dosage of my medical treatments and/or medications I am undergoing or taking (if any), without any professional medical advice;
  4. That the Association does not warrant that their qigong methods, techniques, workshops, trainings, group practices, activities and/or information will be suitable to me and/or meet my expectations;
  5. That there are risks associated with any form of exercise and/or regimen. As such, I agree and undertake as follows:i) To assume all risks, take full responsibility and accountability for my own safety and/or life for all eventualities which may take place during My Participation; andii) To 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 on all their legal responsibilities in all circumstances irrespective of how from caused and whether or not they are caused by the personnel’s mistakes or negligence in the event I suffer from death, any future or current discomforts, accidents, incidents, injuries, damages, losses whatsoever in future which may arise due to My Participation and/or as a result of me practicing any qigong methods and/or techniques as may be taught and/or promoted by the Association; and
  6. That if I faint during My Participation, the Association will call an ambulance and/or perform CPR or AED on-site (whichever is applicable).

 

Article 5 Special Reminders

I have been clearly informed and advised by the Association as follows:

  1. That there are differences in each regimen, school and method of qigong exercise;
  2. That in the beginning, I need to learn and practice qigong single-mindedly to obtain the best results; and
  3. The trainings provided by the Association do not contradict with other forms of exercises, yoga, massage (tuina), acupuncture, folk therapy, zen meditation etc., and I may engage in all the other activities as usual and eat normally during my period of practice.

 

Article 6 Outdoor Group Practices/Trainings

  1. I voluntarily agree to participate in the outdoor group practices and/or trainings organized and/or conducted by the Association and I understand that they are organized and/or conducted for members’ benefits.
  2. The Association has the right to make changes to and/or cancel any trainings and/or practices without the need to inform me or seek my consent.

 

Article 7 Consent to Authorization

I agree that for the entire duration of the workshop(s), the Association may record videos, audios and take photos of the workshops and/or trainings and I authorize the Association to use such photographs, video and/or audio recordings, my response reports, testimonies etc. for any purpose the Association deems fit including but not limited to purposes of data

collection, publications, online publications etc.

 

Article 8 Collection of Personal Data

I agree and consent to the collection and use of my personal data by the Association and/or their personnel for purposes the Association deems fit.

 

Article 9 Turning Off Mobile Phones

I understand that mobile phones’ signals may impede and affect the quality of qi transmission and I agree to turn off my mobile phone(s) immediately upon entering the hall and/or classroom(s).

 

Article 10 Taking Care of Belongings

I understand that the hall is a public place and I have to take care of and be responsible for my personal belongings and that the Association shall not be in any manner responsible for any losses, damages whatsoever of any items in the hall. I shall indicate my name on my personal belongings and on any workshop(s)’ items handed to me immediately including but not limited to any handouts, complimentary gifts etc.

 

Article 11 Principles to Follow

  1. I agree to abide by the principle of “Honour the teacher and respect his/her teachings”.
  2. I agree, undertake and covenant not to make and/or disseminate in any manner any information which may be unfavourable and/or defamatory to the teacher(s) and/or the Association which I may come across during or after the workshop(s)’s period.
  3. I understand that if I make, disseminate or distribute or cause to make, disseminate or distribute any information which potentially defames and/or affects the reputation of any of the teachers(s) and/or the Association, the Association and/or the teacher(s) shall be entitled to take the necessary legal actions against me, costs and expenses of which shall be borne solely by me. I further agree to bear all losses and damages which may be suffered by the teacher(s) and/or the Association as a result of the same.

 

Article 12 Declaration of Health Conditions

  1. I hereby confirm that I have filled up all the necessary forms prior to my admission as a member to the Association, including but not limited to the physical health declaration form, major illnesses declaration form and the membership application form.
  2. I understand and agree that the terms and conditions of the aforesaid forms shall be binding to the full extent permitted by law and shall also bind my heirs, personal representatives, successors in titles and permitted assigns.

 

Article 13 Agreed Matters

I have read and agreed to all the terms and conditions of this form and I agree to be bound by the same.

 

Article 14

If I disagree with any of the terms and conditions herein contained, I shall not proceed to apply to join the workshop(s).

 


 

Health Condition Declaration Form (身体健康状况告知同意书)「身體健康狀況告知同意書」

 

Those with the health condition listed herein shall sign this consent and declaration form if he/she wishes to apply for a term membership in the Association.

 

I ________________________ 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 have been informed that since I have sought medical advices or was treated in the past for

or is currently being treated or is suffering from any of the illnesses and/or health conditions

listed herein, it is recommended for me to seek medical advices from professional physicians

to assess my physical strengths, fitness and abilities before attending and/or participating in

any of the workshops, trainings, group practices and activities of the Association.

I hereby declare and confirm that 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 health

conditions (please tick whichever relevant):

 

  • Unexplained chest discomfort (chest tightness, chest pain)不明原因的胸部不适(胸闷、胸痛);
  • Unexplained breathing difficulties不明原因之呼吸困难;
  • Unexplained vertigo不明原因之晕眩;
  • Dizziness头晕;
  • Hypertension (above 140/90Hg)高血压(140/90Hg以上);
  • Asthma气喘;
  • Alcohol or drug abuse and/or addiction酒精或药物滥用成瘾;
  • Diabetes mellitus糖尿病;
  • Hypotension低血糖;
  • Hyperlipidemia (total cholesterol greater than 240 mg/DI)高血脂症(总胆固醇大于240mg/DI);
  • Anemia (aplastic anemia, thalassemias)贫血(再生不良性贫血、地中海型贫血);
  • Eesophageal/gastric/duodenal ulcer (malignant tumour) etc.食道、胃、十二指肠溃疡、癌症(恶性肿瘤)等;
  • Others, please state其它,请列出:_____________________

 

Due to my illnesses and/or health conditions, I fully declare and confirm that I am fully aware

and understand all of the following:

 

  1. That the purpose of the qigong practice is to improve my overall health conditions but it shall not in any manner be a substitute to any of the medical treatments and/or medications that I am undergoing or shall undergo, taking or shall take;

 

  1. That the Association does not warrant that their qigong methods, techniques, workshops, trainings, group practices, activities and/or information will be suitable to me and/or meet my expectations;

 

  1. That during my participation in any of the workshops, trainings, group practices and activities which may be organized and/or conducted by the Association or otherwise, irrespective of the location of which the same is being conducted or held at, in group, individually or otherwise (“My Participation”), I must:-i) At all times assess and monitor my own physical strengths, fitness, abilities and health conditions and not overexert and/or perform any improper techniques, exercises and/or physically exhausting activities and adhere to the guidance and instructions of the Association; andii) Immediately stop practice and forthwith seek medical attention and assistance in the event I experience and/or suffer any discomfort, pain, headache, bleeding, dizziness, vomiting, injury etc. or encounter any accidents and/or incidents including but not limited to falling or bruising.

 

  1. That there are risks involved in any form of exercise and/or regimen. As such, I agreeand undertake as follows:i) To assume all risks, take full responsibility and accountability for my own safety and/or life for all eventualities which may take place during my Participation; andii) To 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 on all their legal responsibilities in all circumstances irrespective of how from caused and whether or not they are caused by the personnel’s mistakes or negligence in the event I suffer from death, any future or current discomforts, accidents, incidents, injuries, damages, losses whatsoever in future which may arise due to My Participation and/or as a result of me practicing any qigong methods and/or techniques as may be taught and/or promoted by the Association; and

 

  1. That if I faint during My Participation, the Association will call an ambulance and/or perform CPR or AED on-site (whichever is applicable);

 

I have read all the above terms and conditions in detail, and I understand and agree that the terms and conditions of this consent and declaration form shall bind my heirs, personal representatives, successors in titles and permitted assigns.

This declaration of consent is valid and binding to the full extent permitted by the law of the country the Association registered.

 

I hereby confirm that I have read, understand and agree to all the above terms.

 

 

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