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Name *

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Which service(s) you are interested in scheduling? *

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Reiki ReLaunch Website Promo Package

Ascend & Align: 3-Month Reiki Life Coaching

Private Sound Healing Workshops

Retreats

Other

Do you have any injuries, physical health, or mental health concerns that we should know about? *

medical history

Yes (please provide details below)

No, I do not have any medical injuries or medical concerns

Terms & Agreements *

By completing this form, I hereby agree to the following Terms and Agreements: I am participating in any and all services with Orishas Playground including but not limited to Yoga, Reiki, Chakra Balancing, Sound Healing, Coaching Sessions, Astrology Reading, House Blessing, and other related services, and products do so willingly of sound mind and body. I understand that if participating in Yoga, I will receive information and instruction about the practice and I recognize that yoga requires physical exertion that may be strenuous and may cause injury. I am fully aware of the risks and hazards involved. I understand that the instructor may sometimes physically adjust a student during yoga classes/workshops. If I do not want such physical adjustments, I will inform the instructor at the beginning of each class or session. I understand that if participating in Reiki, it is a Japanese energy technique used for alleviating stress, pain management, stress reduction, and deep relaxation and is not intended to cure or prevent any medical condition. I understand that participating in any of Orishas Playground's services does not involve diagnosing any conditions, prescribing or performing medical treatment, prescribing substances, or interfering with the treatment of a licensed medical professional. I understand that it is recommended that I see a licensed physician or licensed healthcare professional for any physical or psychological ailment I may have. I understand that Reiki, and other services and products offered by Orishas Playground can complement any medical or psychological care I may be receiving; however, they are not a substitute for any medical treatment by a trained physician. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any of these services. I further understand that if I become pregnant, it is my responsibility to inform the instructor and consult a physician prior to and regarding my participation in any of these services. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in these services. In consideration of being permitted to participate in these services, I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating. I knowingly, voluntarily, and expressly waive any claim I may have against Orishas Playground, its instructors, agents, assistants, and representatives for any injury or damages that I may sustain as a result of participating in the service. I, my heirs, or legal representatives forever release, waive, discharge, and covenant not to sue Orishas Playground, its instructors, agents, assistants, and representatives for any injury or death caused by their negligence or other acts. Results may vary. Information and statements are for educational purposes only and not intended to replace the advice of your physician. Orishas Playground does not provide medical advice, prescribe treatments, mitigate, cure, prevent, or diagnose illness. If you are experiencing a medical condition or health concern, be sure to consult with your healthcare provider.

I agree