PLEASE READ CAREFULLY. BY SIGNING THIS FORM YOU ARE 

WAIVING ALL RIGHTS TO COMPENSATION IN CASE OF INJURY.

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Firewalking Liability Release Form and the Assumption of Risk

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I understand that my participation in this training being conducted by Elemental Empowerment and Gregory Scott Frances, @cielos.collective, is completely voluntary and at my own risk. I also understand that no assurance guaranteeing my safety is being made and I agree to hold the sponsors, facilitators, organizers, staff, and property owners completely harmless of all liability if I sustain any injuries. By signing this waiver, I attest that I am older than eighteen years of age and I agree to assume full responsibility for any injury or injuries, physical, mental or otherwise, that I may sustain by participating in this SEMINAR. I acknowledge that I have been told there are outdoor activities, and intense physical exercises involved in the event, and therefore, there is a possibility I may receive injuries requiring medical attention. I agree not to bring any suit for damages, regardless of whether or not negligence can be demonstrated, and I release all parties associated with the firewalk from responsibility for any damages suffered by me, physical or financial. In the event of my death, this shall be binding on my heirs. My signature below indicates that I have read and that I understand everything contained in this waiver. 

 

By signing this form I also release any and all photographs and/or videotape of myself that may be obtained during this seminar to be used by the Elemental Empowerment for publication and/or promotional purposes.