Class Registration - Reiki Dome

REGISTRATION FORM

First Name

Last Name

Cell Phone

Address

City

State

How did you hear about us?

Medical conditions, Injuries, personal notes

You can attach a photo for energy diagnostics or other information

I understand that Alex Akselrod is a Reiki teacher dedicated to sharing his knowledge, tools and resources with clients. His services are meant to be support in addition to any other medical treatments necessary. Reiki teachers do not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a doctor. I understand that Reiki therapy does not take the place of medical care. It is recommended that I see a physician for any physical or psychological ailment I may have.

E-Signature (Full Name)

Date

When you register, additional information will be sent to you. Email Alex at reikidome@gmail.com if you have any questions.

We require a deposit for in-person training to save your spot in a class. Deposits are non-refundable. You may use the amount toward a future class or workshop, as long as you provide a 72-hour advance notice; shorter notification will result in forfeiture of the deposit. Remainder of the payment is due when you come to class.

REGISTRATION FORM

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