New Student Form

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New Student Form

Email *

First and Last Name *

How do you want your name printed on your Certificate when you complete the Reiki training? *

Cell Phone *

Address *

City, State, Zip *

Emergency Contact *

Are you currently under the care of a physician? *

Yes

How did you hear about Renaissance Reiki? *

Have you had a Reiki session before? If so, approximately how many *

Have you taken a Reiki class before? *

Yes

If yes, When and Where was your training? Type N/A if does not apply. *

If yes, Do you practice self Reiki daily? Type N/A if does not apply. *

If yes, what Style and Level of Reiki training have you learned? Type N/A if does not apply. *

Why have you chosen to learn Usui Holy Fire lll Reiki? *

How do you see yourself using the Reiki skills that you learn with Teresa? *

From the dates available on my Class Calendar, what date do you want to take Holy Fire III Reiki Level 1? or

1 & 2? or Master level Training?

Online Class Etiquette: *

Behave as if you are in an in-person class.

Be present during the entire class.

Use video during the entire class.

Participate in all class activities.

Use a quiet private place for you to participate in the class.

Use a separate room so as not be interrupted by your family or pets.

Make sure other members of your household know you will be busy and not available during class time. Ask them to be quiet as you will be in class.

Refrain from doing other things while in class.

Refrain from being on other online apps or devices during class.

Make sure you are comfortable and that you are in front of your screen in view of you camera while in class.

Use mute during the Experiences, Placements and Ignitions so background noise will not bother the other students.

Chat etiquette - be considerate on chat. Stay on topic, ask relevant questions, or make relevant comments.

Come back promptly from the breaks and lunch. Class will not begin until all are present. Note that you will be holding up class for the other students if you do not return from breaks and lunch on time.

Check Here - if you agree with and agree to follow the online class etiquette

Waiver and Consent: I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, or interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health-care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long-term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. *

I Agree and Sign this form by checking this box

Today's Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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