I, , a student of Shaolin Chi Mantis, understand that whatever physical or mental risks are possible, I will not blame anyone else, sue in court, or hold responsible Richard O'Connor, Buddha Zhen Shen-Lang, or any Shaolin Chi Mantis/Tai Chi Youth students and Instructors for any harm or accidents that may befall me. I am confident of each Shaolin Chi Mantis Instructor's abilities and concerns toward my safety, yet I realize that in studying the martial arts accidents take place and that everyone in the school is diligent to avoid hurting one another or ourselves, I further agree to RESPECT THE RULES and advice of my Instructors because their experience has given them a better understanding of what is best for me in a general sense.

I also agree to NOT TEACH any other individuals what I learn in any Tai Chi Youth or Shaolin Chi Mantis class, seminar, or private instructions unless permission is granted by the SCM Patriarch, and will not use the name of this school, Tai Chi Youth, Shaolin Chi Mantis, Shaolin Zen, Shaolin Records, Shaolin Music, Shaolin Communications, or its affiliated companies for any purposes without written permission from the Patriarch of Shaolin Chi Mantis. I understand that until I am a CERTIFIED TAI CHI YOUTH INSTRUCTOR or a CERTIFIED SHAOLIN CHI MANTIS SHIFU I am not capable of teaching others.

I hereby sign a copy of this RELEASE AGREEMENT to verify my understanding and agreement of the information on this Release which means: I realize that Tai Chi Youth, Shaolin Chi Mantis, Shaolin Communications, and Buddha Zhen may have no insurance coverage or health plan, I hold no one but myself responsible for any type of injury I may obtain, I will use my best judgment and awareness to protect myself and other students, and I will not teach or sell any of the information I'm taught in any Shaolin Chi Mantis or Tai Chi Youth class/workshop/seminar.

The undersigned STUDENT hereby grants to Tai Chi Youth Inc., Shaolin Chi Mantis, and Shaolin Communications the right, but not the obligation, to use Student's name, voice, and/or likeness, and/or any film or photographs taken by you of each of us individually or with others in and in connection with the activities of Tai Chi Youth and Shaolin Chi Mantis, advertising, production, distribution, and exploitation of, forever and throughout the world in any manner and by any means whatsoever, including all forms of digital media.

 Sincerely:      Date:  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    01 02 02 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

 Parent Signature:      Date:    Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec      01 02 02 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

(If Student is under 18 years of age, the Parent Signature is required).

Student EMAIL ADDRESS:  (Required)