Reiki Student Application Form

Name

First NameLast Name

Birth Date

MonthDayYear

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

City

How did you hear about this training?

What is drawing you to Reiki at this time in your life?

What are you hoping to receive from this training?

Do you plan to practice Reiki:

For personal use onlyFor family/friendsProfessionallyUnsure

Have you received Reiki sessions before?

YesNo

Have you taken any previous Reiki training? If so, where and when?

Do you currently practice meditation, yoga, breathwork, or other spiritual/self-awareness practices?

Reiki can bring emotional awareness to the surface. Are you currently in a stable place emotionally to engage in self-reflection?

YesNoUnsure

Is there anything you feel I should know to support you safely during this training? (optional)

This training requires punctuality, presence, and respect for shared space. Are you able to commit fully to the scheduled dates and times?

YesNoUnsure

Are you willing to practice Reiki between training weekends?

YesNoUnsure

I understand that completion of this course does not guarantee professional certification beyond the training provided, and registration with a governing body is required to become a Registered Reiki Practitioner or Teacher. The training provided will qualify you to be able to apply to the Canadian Reiki Association.

I understand

I understand that Reiki is a complementary wellness practice and does not replace medical or psychological care

I understand

Is there anything else you would like to share about yourself or your intentions?

Which dates and times are you available to meet over Zoom prior to beginning the course (student interview).

Reiki is a healing technique that uses the universal life force energy to balance the subtle energies within our bodies to heal and contributes for balanced physical, mental, emotional, and spiritual being. Reiki is not a replacement for traditional medical treatment.

During a Reiki session, your Reiki practitioner will lay their hands on your body in a series of hand positions to deliver Reiki energy. You might feel a floating sensation, emotional release, increased relaxation, enhanced sense of balance, centeredness, and calm.

The effects of Reiki are cumulative in which regular Reiki treatments can invite significant improvement. Regular sessions support well-being in every way.

If you experience any pain or discomfort during this session, immediately inform the practitioner.

Please sign below if you acknowledge the given information and give your consent to recieve the treatment.