Waiver & Release Form

I HEREBY WAIVE AND RELEASE We Qigong, Energy Eclectics, 5 Virtues Medical Qigong, and any of their representatives or affiliates from liability pertaining to the matters set forth below.  I understand that by signing this Waiver and Release, I expressly and willingly agree to assume complete responsibility for any risk of injury that may arise from the below related activity.  On behalf of myself, my heirs, assigns and next of kin, I waive all claims for damages, injuries and death sustained to me or my property, that I may have against the above named Released Party relating to such activity.  I understand that although the activities are not inherently dangerous, personal injury may occur including bodily injury, damage to personal property and/or death.  I assume any risk and take responsibility and waive all claims of personal injury, bodily injury, damage to property or death relating to all activities associated with workshops, classes, exercises or any qigong, meditation, healing or class activities pertaining to this workshop.  If I am injured from activities in this workshop, I will not hold the Released Parties responsible even if the injuries were caused by negligence on my part or the Released Party or any other party under or affiliated with the above named Released Parties.

I do not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent me from participating in the above-mentioned activity, and if required will obtain a medical examination and clearance.

I also understand that medical qigong is a form of complementary and alternative medicine not licensed by the State of Tennessee, nor is licensing of this modality required in the State of Tennessee; energy healing in general is not regulated in the state. In practicing complementary and alternative medicine our goal is to support, rather than replace the care of my existing physician, therapist, or acupuncturist.  We do not diagnose nor promise to cure any condition, disease or ailment.


I understand that the facilitators of this event are not licensed physicians or licensed health care practitioners and that the information presented is for educational purposes; it is not meant to diagnose or cure any specific ailment, disease or medical condition.


I understand that Medical Qigong is a branch of Traditional Chinese medicine. It is a system of health care that recognizes the root causes of symptoms or disease and treats the client as a whole person. Practiced as an adjunct to Western medicine, medical qigong addresses the energetic imbalances or blockages that contribute to illness.  Medical qigong is not a panacea but a healing modality that has been practiced in China for over 2,000 years.