Taichi Registration & Payment

Note: If you are registering for two, please enter both names in the form if both contact info are the same.

Registering Session (class time)

Student Name(s)*

Birthday(s)*

Email*

Phone*

Home Address*

Alternative/Emergency Contact Info*

Do you have any health condition or injuries that we should know about?*

Initial here if you are to bring a check for the entire session on the first day of class.

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NOTE: ONLY COMPLETE THE NEXT SECTION IF YOU ARE TO MAKE MONTHLY PAYMENTS

Please do not complete the section if you are paying the session in full via check.

Please select a monthly payment

Monthly Payment is only available through Paypal. Major credit cards accepted. If you are registering for two, make sure to subscribe for the second person. We'll send a confirmation email within 24 hours upon successful online payment. You may also pay for the session in full via check. Make sure to include the student name(s) on the check and bring it on the first day of class.

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