Teen Reiki Level 1 & Rite of Passage: Registration Form

Teen Reiki Level 1 & Rite of Passage: Registration Form

Provided by Rosalyn Acosta, Founder Live Heal Travel
Parent/Guardian Full Name*

First NameLast Name
Email*
(All communications, invoices, and the intake form link will be sent here.)
Phone Number*
(Best number to reach you, especially during the training day.)
Teen's Full Name*

First NameLast Name
Teen's Preferred Name / Nickname
Teen's DOB*

MonthDayYear
Date
Teen's Pronouns

She/HerHe/HimThey/ThemOtherPrefer not to say
Allergies & Dietary Restrictions*
(Please list any food allergies or restrictions. We will be providing healthy snacks.)
Medical or Sensory Considerations*
(Please share anything that would help us create a more supportive environment for your teen, such as anxiety, ADHD, or sensory sensitivities. This information is confidential and helps me prepare for their 1:1 session.)
Emergency Contact Name (if different from above)

First NameLast Name
Emergency Contact Phone (if different from above)
Please enter a valid phone number.
Preferred Date for Introductory Session*

Sunday, March 8, 2026Sunday, March 15, 2026
Policies & Agreements

To secure your teen's spot, a $50 non-refundable deposit is required upon registration. The remaining balance of $175 is due by January 31, 2026.

We do not offer refunds. However, if you must cancel after paying your final balance, your full payment of $225 will be converted into a full credit.

This credit is valid for 6 months (until September 30, 2026) and can be used for any future 1:1 session, program, or workshop.

Transferable Registration: As an alternative, you are always welcome to find another family to take your teen's spot. Please just notify us of the name change at least 48 hours before the event.
Agreement 1:*

I have read and agree to the Cancellation & Credit Policy.
Agreement 2:*

I understand that a link to the mandatory Intake & Liability Form will be emailed to me and I agree to complete it before my teen's introductory healing session.
A $50 non-refundable deposit is required to complete your registration and secure your teen's spot. The remaining balance of $175 will be invoiced separately and is due by January 31, 2026.

Teen Reiki Training - Registration Deposit

$50.00 Quantity

Total

$0.00

Credit Card Details
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Credit Card Number	Security Code
Card Expiration

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