Teen Reiki Level 1 & Rite of Passage: Registration Form for Oct. 4, 2026
Provided by Rosalyn Acosta, Founder Live Heal Travel
Parent/Guardian Full Name
*
First Name
Last 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.)
Format: (000) 000-0000.
Teen's Full Name
*
First Name
Last Name
Teen's Preferred Name / Nickname
Teen's DOB
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Teen's Pronouns
She/Her
He/Him
They/Them
Other
Prefer 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 Name
Last Name
Emergency Contact Phone (if different from above)
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Date for Teen's Private Reiki Session with Rosalyn
*
Sunday, Sept. 20, 2026
Sunday, Sept. 27, 2026
Policies & Agreements
Tuition & Registration: Full tuition of $350 is due upon registration to reserve your teen's spot in the cohort and secure their 1:1 private pre-session time slot.
Cancellation Grace Period: Cancellations requested on or before September 15, 2026 will receive a full refund minus a $50 administrative fee.
Cancellations Beginning September 16 & Sickness Policy: Due to the intentionally intimate circle size and limited number of teens admitted to each cohort, tuition is strictly non-refundable starting September 16, 2026. If an unforeseen conflict, emergency, or illness arises after this date, 100% of your payment will be converted into a full credit.
Family Credit: Your credit is valid for 6 months (expires April 4, 2027) and may be used toward any future 1:1 session for your teen, yourself, or any member of your immediate family.
Transferable Registration: You are welcome to gift or transfer your teen’s spot to another family with at least 72 hours' notice prior to October 4. Please note that for transfers made after the September pre-session dates, the incoming teen will participate in the full-day immersion on October 4, but the pre-session components cannot be rescheduled.
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.
Agreement 3:
*
Parent/Guardian Distance Intro Session ConsentI agree to participate (or designate another parent/guardian) in a brief, complimentary distance energy session. I understand this does not require logging into a live virtual call; the practitioner/Rosalyn will reach out to receive one focused intention, tune in remotely, and share insights via email. This session is designed to give parents a direct, personal sense of the energy and tools their teen will be experiencing.
Teen Reiki Training - Registration
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Teen Reiki Training Registration
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