New Client Form Go backYour message has been sent Name(required) Warning E-mail(required) Warning Phone(required) Warning Address Warning Emergency Contact(required) Warning Date of Birth Warning Do you have any areas of concern? Warning Please list any medical issues and/or important medical history: Warning Have you ever practiced Yoga or Reiki? If so what kind/how long? Warning Agreement of Release and Waiver of Liability~Student Waiver Agreement I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. As is the case with any physical activity, the risk of injury is always present. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. Yoga and/or Reiki are not substitutes for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga or reiki. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Heather Reiners. Please check box below confirming you have read and understand the waiver: (required) Warning Warning. Submit Δ Thank you! Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook Like Loading...