New Client Form Name(required) E-mail(required) Phone(required) Address Emergency Contact(required) Date of Birth Do you have any areas of concern? Please list any medical issues and/or important medical history: Have you ever practiced Yoga or Reiki? If so what kind/how long? 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) Submit Δ Thank you! Share this:TwitterFacebookLike this:Like Loading...
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