For questions please email coastalmed@shaw.ca or call 250-384-1700. If you are calling please leave a
message and your call will be returned.
Name: ___________________________________________________________
Waiver and Release: Regarding my participation in the “Qi Gong for Health Vitality & Longevity” workshop conducted by Jeffrey
Chand, I, the undersigned, agree to hold harmless, indemnify, and release Jeffrey Chand and Coastal Integrated Medicine from all
liability for damage or injury to myself or any person or property resulting therefrom. I accept full responsibility for damage or injury
which may result. I have read, understood and agree with all of the preceding statements in this waiver and release:
Registration must be received one week prior to the course. Late registrations will be accepted on a space available basis. Cancellation
must be confirmed in writing five days in advance.
Please wear comfortable loose clothing. Pack a lunch or you are welcome to eat out.