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In order to be sure our sessions are planned effectively, please RSVP to the monthlyemail reminders you will receive. This will allow each session to be planned with exercises that will most benefit each participant.

Please read and affirm the following statements thoroughly:

Disclaimer: Seattle Wushu Center, its employees and instructors make no claims of medical cures as a result of Qigong practice. Although Qigong is a very safe method of exercise, it is suggested that you consult your physician before beginning the practice of Qigong. I understand that activities or therapies such as Qigong, Reiki, LingQi, Tuning Fork sound therapy, Quantum touch, etc., are non-denominational practices and will not interfere with my current beliefs. I understand that Qigong Instructors and Energy therapists cannot prescribe medications, herbs, or tonics, nor can they give me medical or psychological advice unless they are licensed and accredited medical practitioners or psychologists. I understand that Qigong, Reiki, etc complements standard medicine but is NOT a substitute for standard medical practices, and that if I am currently undergoing medical treatments with any medical professional, that I will continue with such treatments as regulated by my Primary Doctor. I understand that if I desire to teach Qigong to others or to professionally provide Qigong or LingQi as an energy therapy for others, that I must undergo a Qigong/Energy Work course under Ms. Restita DeJesus before doing so (courses will be at a separate fee).

By clicking "yes" below, it affirms that I agree with this statement and I agree to participate in the free Qigong practice.


Address, City, State, Zip*

Email (you will receive monthly reminders of the Qigong gatherings)*

Home Phone

Cell Phone

May we text the above cell number? (reminders only)

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Are you allergic or bothered by the scent of incense, essential oils, burnt sage, etc? Yes*

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If "Yes" to the above question, please state what scents your are allergic to, or are bothered by:*

Will you be needing a chair to sit on for the sessions? (for mobility-challenged participants)*

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Select one:*

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