Blaze - “The Mastery of Fear”
Voluntary Release Form
For Firewalk Seminar
PLEASE READ CAREFULLY
By signing this form you are waiving all rights to:
COMPENSATION IN CASE OF INJURY
WARNING!
If you attempt the firewalk under the influence of alcohol or other drugs affecting the operation of your nervous
system, you will probably receive burns.
I fully understand and acknowledge that there are no requirements whatsoever to walk or participate in this event and
that I do so out of my own free choice. I also understand that to walk across the fire bed can be dangerous if the
training and instruction I am given is not fully adhered to by me. I therefore commit to follow and implement the
training and instruction without deviation.
In consideration for my participation in this event and by endorsement below, I agree to release and hold harmless
Karen Sterling and Blaze Firewalking Ltd, their agents, assistants, employees, independent contractors and cosponsors for any liability whatsoever - any damage or injury, physical or mental, which I might incur as a result of my
voluntary decision to walk across the fire bed.
Firewalking must not be carried out if pedicures and/or foot treatments have been carried out three days prior to
Firewalking event. Foot creams and/or sprays are not used on the day of Firewalking.
If I do choose to walk across the fire bed with my bare feet, I affirm that I have not been coerced or persuaded in any
way to do so and acknowledge that I make this decision voluntary and without reservation. I acknowledge that I have
been advised that there is a possibility that I may receive burns requiring medical attention and I release all others
from any damages whatsoever. I am fully aware and acknowledge that I am physically and mentally able to perform
the physical aspects of walking across the fire bed and the mental aspects of receiving and understanding the spoken
words of the trainer.
Having assessed and understood this Release Form and understood what is required of me to successfully walk across
the fire bed, I hereby elect, by my signature below, to release Karen Sterling and Blaze Firewalking Ltd from any
claims heretofore and thereafter arising both physically and mentally, from my participation in this event. By signing
the Voluntary Release Form I also agree with Karen Sterling and Blaze Firewalking Ltd not to offer any classes,
workshops, seminars or private instruction of any kind which contain Firewalking without the express written consent
of Karen Sterling and Blaze Firewalking Ltd and that such consent shall not be given without my first completing an
Instructor’s Program given, or approved by Blaze Firewalking Ltd. I also confirm that I am aware that the body of
knowledge contained in Blaze -. “The Mastery of Fear” Firewalk seminar is protected by copyright.
I acknowledge that I have been given the opportunity to ask questions regarding any aspects of the Release contained
herein, and by signing below, I do acknowledge that I have carefully read and understood all aspects of the Release
and agree to the terms in their entirety.
In the absence of any negligence or other breach of duty by Karen Sterling and Blaze Firewalking Ltd, participation in
the Fire walking Seminar is entirely at the participant's own risk. Karen Sterling and Blaze Firewalking Ltd are insured
against loss or injury caused through their negligence.
I also grant Karen Sterling and Blaze Firewalking Ltd permission to use statements, video images, photographs and
other likenesses of myself resulting from my participation in this event.
(Print Name) _______________________ (Signature)
________________________
(Date)
_______________________ (Witnessed by) ________________________
(Email Address)________________________________________________________________________
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