Reiki Course Registration Form

Name

Email Address

Phone Number

Date of Birth (DD/MM/YYYY)

Address

Emergency Contact Name

Emergency Contact Phone Number

Are you trained in other therapies? Yes/No. If Yes please specify

Current roles and responsibilities: Are you self employed?

Highest level of educational attainment: certificates could aid your accreditation.

Previous experience of Reiki:

Why do you wish to train in Reiki?

Would you like to mention anything else e.g. health issues or learning needs that it would be useful for me to know about?