Hearts on Fire Main Page

Please join us for this increditiable firewalking event!

Release Form

Hearts on Fire presents; a firewalking workshop that will explore our fear and limiting beliefs and discover possibilities that have remained untapped within us. Tonight’s activities embrace physical activities that stretch our capacity for peak performance in our lives. Participation is voluntary, and you will receive a benefit whether you participate walking on the fire or not.

PLEASE READ CAREFULLY
I understand that my participation in the Firewalk workshop is completely voluntary, under my own free will and at my own risk. I also understand that no assurance guaranteeing my safety is being made, and I agree to hold Hearts on Fire and Maria Nokimos, facilitators, organizers and property owners completely harmless of all liability. By signing this waiver, I agree to assume full responsibility for any injuries, both physical and mental, that I sustain by participating in this firewalking Experience and acknowledge that I am herewith being told the following:

1. People have, in fact, been injured by participating in firewalking.
2. There is, in fact, an inherent risk in firewalking: and
3. There is a possibility that I may receive injuries requiring medical attention.

My signature below indicates that I have read and that I understand everything contained in this waiver; that I agree not to bring any suit for damages, regardless of whether or not negligence can be demonstrated; and that I am releasing all parties associated with the Firewalk from damages whatsoever.

Name (Please print clearly)__________________________________
Street Address_____________________________________________
City__________________________State_____________Zip________
Telephone__________________________
Signature___________________________Date__________________
Email Address:_____________________________________________

For a PDF version of this form click here