Application for Student Enrolment Fill out the form below or download the pdf version below and email to info@goldenphoenixtaichi.com Download PDF Enrolment Form Student Enrolment Given Name * Family Name * Gender * Male Female Date of Birth * Email Address * Address * Suburb * Postcode * Telephone * Home Business Phone Business Mobile Phone Mobile Profession * Skill Hobby Emergency Contact * Name Emergency Email * Email Medical Information Please select any pre-existing medical conditions Heart/Cardiovascular Disease Asthma/Breathing Disorders Diabetes Orthopedic Concerns Psychological Problems OtherOther Blood type if known Previous Martial Arts Experience Martial Tai Chi Chuan Tai Chi for Health OtherOther I hereby give permission for photographs/images of myself to be used on: www.jmhconsultau.com.au, Facebook Julie M Hutchin Goldenphoenix Taichi, Facebok Julie M Hutchin Consulting Australia, Google+, LinkedIn, Spiritualnetworks.com, Google Bloggers, Connect Magazine * Yes No Allow me to inspect the images first Waiver & Release Form * Acknowledgement Waiver & Release from Liability Read carefully and check. Read Waiver Δ