Pro BONO Session Application

Complete the below form to apply for a spot on the River Street waitlist for a free Reiki session. All pro bono sessions will occur on Fridays in Cobble Hill, Brooklyn. Please note below if you would prefer a virtual experience.

Name

First Name

Last Name

Pronouns

Race & Ethnicity

Indigenous or First Nations

Yes

Age

Sex/Gender Identity

[as you identify]

Sexuality

Ability/Disability Status

[please disclose as preferred. feel free to describe accommodations, i.e. KN95 masking, needed to support your access to a session. please note that River Street is unfortunately not an accessible office at this time, with a one level staircase between the entryway and office]

Employment, Student Status, etc.

[briefly note relevant information surrounding current status]

Financial Need

[briefly describe need for supported access]

Referred By

Health or Mental Health Diagnoses

[please disclose as preferred]

Reiki History

[history of receiving energy therapy or other body work, your own energy work/practice, etc]

Anything Else?

[anything else you'd like to share?]

Please Note:

All sessions will be held in person on Fridays in Cobble Hill. If you require or would prefer a virtual meeting or have other notes or questions about pro bono sessions, please list them below.

Priority for pro bono sessions will be given to BIPOC/MGM, trans and GNC folks, and those holding other historically oppressed identities. If you are contacted for a free session, best attempts to work with your schedule will be made, but available dates and times of day may be limited. If you do not respond scheduling attempts within 3 business days, your offered date options may be moved back slightly in order to extend a sooner date to another community member.

Pro BONO Session Application

RIVER ST. REIKI