Reiki for Tweens and Teens Registration and Parental Consent Form
Please fill out this form to indicate your consent for your child to attend the online Reiki for Teens and Tweens Workshop for ages 11-15.

When: Sunday, April 3rd, 2022 from 10 am - 2 pm
Where: Neighborhood Acupuncture, 345 Main Street, Laurel, MD

Questions/Comments:  443-766-0894 or jessica@gentlehandsreiki.com

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Email *
Parent Name *
Child Name(s) *
Primary Phone Number *
Emergency Contact (other than parents) *
Emergency Contact phone number *
Are there any custody issues we should be aware of?
Photo Release:  I give permission for my child(ren)'s likeness to be possibly be shared on social media or placed in online advertising. *
How did you hear about this class?
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I understand that my child will be learning Reiki, a mode of channeling energy based in spiritual practice.  I understand my child will not be engaging in specific religious practice.  I give consent for my minor child to attend the workshop.  I, as a parent, understand that Reiki healing may result in my child experiencing minor, short-term physical sensations such as tingling or mild light-headedness as they practice.  (Please initial below) *
I understand that Jessica Sharp's classes are a welcoming, affirming environment.  I understand that if my child refuses to respect fellow students in class, including disparaging or deliberately mis-gendering them, that my child may be removed from the group.  I understand that my cost for the class will not be refunded in this instance. (Please initial) *
I understand that this class will include a lunch break and my child will bring a lunch.  (Please initial.) *
I agree to pay the registration fee of $99 per child.  I understand that my child's registration is not complete until payment is received. (Please initial.) *
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