Congratulations on booking your Reiki 1 Course with Suzi at A Wee Retreat

Name

First Name

Last Name

Telephone Number

Emergency Contact Name

Emergency Contact Number

Dietary Requirements

None

Vegetarian

Vegan

Gluten Free

Food allergies

Medical conditions

If you have any medical conditions you should indicate them here or by stating "yes" or state "no". *All information is treated in the strictest confidence. It is your responsibility to inform us of any physical or mental health issue which you may have or any injury recent or past. Also let us know if you are pregnant.

Yes

No

Please detail any medical conditions that you think are relevant

What are you most looking forward to?

Do you have any concerns or questions?

Name for Reiki Certificate

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07736 324882

A Wee Retreat, Peebles, Scottish Borders, Scotland