Self Care with Kimeiko - Reiki Class Registration Form

Prénom*

Nom de famille*

Introduction

Congratulations on beginning or furthering your Reiki journey!

Before completing this form, please confirm class availability and your eligibility to participate with Kimeiko Hotta Dover (she/her/hers), Karuna Reiki(R) Master, at reiki@kimeiko.com or (647) 557-6578.

When you are ready to register, please answer the following questions. You do not need to complete this form if you have already taken a class with me.

About You

Preferred name (if different from legal name above)

Please type your name EXACTLY as you'd like to appear on your certificate *

Preferred Pronouns *

Email *

Phone *

Mailing Address *

Reiki class

Which class are you registering for? *

What is the date of your desired class? *

Audio / visual permission

May I take your picture? *

NonOuiNon

After you have had a chance to review class pictures, I may share your pictures: *

Referral

How did you hear about us? *

Please let me know who referred you so I can thank them!

Would you like to receive the free GTA Reiki e-newsletter? It features Reiki workshops, classes, and other events, and it is distributed about 6 times a year.

NonOuiNon

Reiki Class Registration Form - Self Care with Kimeiko

Thanks for completing the form.

The information has been received.

Thanks for completing the form.

The information has been received.

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Introduction

About You

Reiki class

Audio / visual permission

Referral

Newsletter

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