Alexander Technique Registration

Please fill out the following information and we will contact you within 2-3 business days. If you have questions, please email the Assistant Director of Fitness Programs,  D'Ondra McGee at dm11@rice.edu.  

 

General Information 

Name:  
Membership ID No.:  
Date (MM/DD/YYYY):  
Membership Status:  
Mailing Address:    
Email:  
Age:  
Phone (Cell):   
Phone (Home):  
Primary Care Physician:  
Physician's Phone:  
Physician's Address:    
 

Physical Activity Screening Questions

Regular physical activity is enjoyable and healthy, and for most people safe. Although the Alexander Technique is not an exercise program, some individuals may have health-related risks that might require them to check with their physician before starting individual lessons. Carefully read and answer the following questions. All information will be kept confidential.

(Please answer yes or no to the following questions)

 

Has your physician ever told you that you have a heart condition?
                                                       

Do you experience chest pain when you are physically active?  
                                                       
In the past month, have you experienced chest pain without performing physical activity?  
                                                       
Do you lose balance because of dizziness or do you ever lose consciousness?

                                                       

Do you ever have a bone/joint problem that could be aggravated by a change in your level of physical activity?  
                                                       
Is your physician currently prescribing medication for your blood pressure or heart condition?  
                                                       
Are you a male over the age of 45?  
                                                       
Are you a female over the age of 55?  
                                                       
Do you know of any reason why you should not participate in individual Alexander Technique lessons?  
                                                       

If you answered yes to any of the above questions, it is recommended that you consult with your physician by phone or in person before beginning lessons or participating in a physical activity program.


Alexander Technique Policies and Agreement

 

Payment Policy

Lessons will be prepaid and payment is due at the time of initial appointment. Check, cash, or credit cards are accepted forms of payment, either on the website or in the Recreation Center administrative offices. Make checks payable to Rice University. Paying an Alexander Technique teacher directly is strictly prohibited; all membership privileges to the Gibbs Recreation Center will be terminated if this is violated.

Session Duration

Alexander Technique lessons are 45 minutes in length.

Risk Factor Notice

Students must be cleared of any risk factors associated with physical activity prior to meeting with an Alexander Technique teacher. If a student is identified as high risk, the student must provide the teacher with a signed physician's medical release form stating that the student has been cleared to engage in lessons.

Training Facility

The Gibbs Recreation Center and Rice University will be the training facility for Alexander Technique lessons during the time of appointment. Teachers are not allowed to train under other conditions or circumstances.

Refund Policy

Alexander Technique lessons are non-refundable.

Transfer Policy

All Alexander Technique lessons are non-transferable. All lessons must be paid in full and submitted to the Gibbs Recreation Center Administrative Office.

Late Policy

Alexander Technique students are responsible for arriving in a timely manner to their lessons. The teacher is required by policy to wait 15 minutes beyond the scheduled start time before the lesson is forfeited. If a student's session begins late due to the student's late arrival, the teacher continues with the session and ends at the scheduled time.

Cancellation Policy

Except in the event of an emergency, a minimum of 24 hours notice is required for the cancellation of an Alexander Technique lesson. Failure to cancel within 24 hours or failure to show up for a lesson will result in a forfeit of the lesson. Exceptions will only be made in the case of a medical emergency accompanied by a doctor's note. If there should be a discrepancy, the decision will be determined by the Assistant Director of Fitness Programs. Alexander Technique students should contact their teacher directly should they need to cancel. If a student is unable to reach their teacher, they may contact the Assistant Director of Fitness Programs, D'Ondra McGee, at 713-348-5765. 

                              

 

 

Participation Agreement and Assumption of Risks and Liability

 

I, , desire to participate in the activities and programs of the Barbara and David Gibbs Recreation and Wellness Center (the "Activities") and, in consideration of being allowed to participate in the Activities and to use the machinery and equipment of the Barbara and David Gibbs Recreation and Wellness Center (the "Facilities"), I do hereby acknowledge and agree as follows.

1. I am fully informed and aware that my participation in the Activities and use of the Facilities involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks.

2. I am in sufficient physical and mental health to participate in the Activities and to use to Facilities. I have medical insurance coverage appropriate for my participation in the Activities and use of the facilities, and I have provided medical insurance and emergency contact information below my signature on this agreement. I understand that Rice University shall not provide any insurance for me in connection with my participation in the Activities or use of the Facilities.

3. I fully and forever release, waive and discharge, and covenant not to sue Rice University (including but not limited to, its trustees, faculty, staff, students, agents, and representatives), from and for any and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to, court costs and attorneys' fees), from any cause whatsoever (including, but not limited to, property damage or loss, bodily injury, illness, or death) directly or indirectly arising in connection with my participation in the Activities or use of the Facilities, whether or not foreseen or contributed to by the negligent acts or omissions of Rice University or others.

4. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements, regarding this subject matter. The Agreement (i) may not be amended, by course of conduct or otherwise, and (ii) may not be assigned, in whole or part, except in writing duly executed by Rice University. This Agreement shall be interpreted and enforced in accordance with the laws of the State of Texas, without regard to any conflicts or choice of law principles, and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect and other provision, and this Agreement shall be construed as if such provision, to the extent of such unenforceability, had not been incorporated herein.

5. I (i) have read and fully understand this Agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs, and legal representatives, (iii) intend that this agreement benefit Rice University, (iv) confirm that I am at least 18 years of age, fully competent, and am entering into this Agreement voluntarily and of my own judgment.

 

                              

 

Emergency Contact Name: 

Emergency Contact Phone: