Asian Health and Healing Clinic Registration Form: Spring 2023
Hello, community! We invite you to join us for a day of free health and healing services, health education, and community resources at our Spring Asian Health and Healing Clinic! Little Manila Rising is grateful to be collaborating with Empowering Marginalized Asian Communities (EMAC) for this exciting event.

WHAT (*all services and activities are completely FREE):
- Health Screenings including blood pressure checks, blood glucose checks, dental screenings, diabetes/A1C, and more
- COVID-19 vaccinations (first and second doses, as well as boosters), test-to-treat treatment on site for those who test positive, and COVID-19 tests provided by San Joaquin Health Centers
- Health Education and resources on diabetes, hypertension, nutrition, mental health, oral/dental health, health insurance, immigration rights and green card support, asthma, COVID-19 and more 
- Holistic Healing including Sound Healing, Reiki, Auricular Acupuncture, Hilot/Ablon, and Individual Massage Therapy
- Mindfulness activities including self-care kits, creative arts, and group Zumba 
- Self-defense workshop for all ages
- Wellness activities for youth/children
- Free giveaways including: stuffed animals, books, and hygiene products 
- Fresh produce boxes from Emergency Food Bank 
- Raffle prizes 
- Food will be distributed for lunch by local food trucks *limited, on a first come, first serve basis*

WHO: This event is open to all community members. We welcome all cultures and identities. No ID or insurance required to receive services.

WHEN: Sunday, May 21, 2023 from 10AM to 3PM

WHERE: Trinity Presbyterian Church (1002 W 8th Street, Stockton, CA 95206)

This event is also in partnership with Community Medical Centers, Kaiser Permanente, and Blue Shield California.

If you have any questions, comments, or concerns or need additional assistance with technology or translation support, feel free to contact or call/text us directly at (209) 214-8532. Voicemails are checked regularly. Thank you and we look forward to seeing you!
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What services/activities/resources offered at this event are you interested in? *All are FREE* *
What is your preferred language? (**If Other", please indicate which language you prefer.**) *
Do you have any dietary restrictions? *
WAIVER OF LIABILITY: By signing this waiver agreement ___________________  (your name) agrees to the following terms: 1) The participant agrees that their participation is voluntary at the Asian Health and Healing Clinic at Trinity Presbyterian Church (1002 W 8th Street, Stockton, CA 95206) on Sunday, May 21, 2023. Additionally, the participant agrees to assume any risk that is associated with participating in the event and releases Little Manila Rising, Empowering Marginalized Asian Communities (EMAC), and 209 Asian Pacific Islander Coalition (APIC) from any and all claims of damage and loss that may be as a result of participation. The release is without limitation and includes the personal injury fees, attorney’s fees and any other losses that might occur to the participant. 2) The participant agrees to hold Little Manila Rising, Empowering Marginalized Asian Communities (EMAC), and 209 Asian Pacific Islander Coalition (APIC) harmless against all claims of damage and loss. 3) The participant hereby warrants that they are physically fit and able to participate in the Asian Health and Healing Clinic activities without any undue risk. 4)  Little Manila Rising, Empowering Marginalized Asian Communities (EMAC), and 209 Asian Pacific Islander Coalition (APIC) maintain the right to refuse participation in the Asian Health and Healing Clinic if they foresee that participation would risk damage to any party. 5) This waiver agreement is governed by the laws of California. Any legal claims or lawsuits related to the participants in the Asian Health and Healing Clinic shall take place in courts located in Stockton, CA. 6) The participant agrees that this waiver agreement shall remain in full force and take effect without change and that participation in the Asian Health and Healing Clinic is pursuit to the terms of the agreement.
By electronically signing this form, I agree to the above waiver of liability. Please type your full name below. *
PERMISSION TO PHOTOGRAPH: Occasionally, Little Manila Rising program activities may be photographed, videotaped, or audio taped for educational, publicity or fundraising purposes. Please indicate if you give permission to appear in videos, photos or audio recordings without compensation (e.g., as part of brochures, slide shows or program websites)
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