Courage to Be Yourself

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A full evening workshop about authenticity, vulnerability, trust, and the nourishment and power that flow from allowing others to really see you. The workshop will present a series of challenges, all optional, that bring you to the opportunity to walk unharmed across hot coals. At evenings end, your heart will be open and full of courage. You will remember the night happily for the rest of your life.

LEARN MORE about firewalking and this event at 🔥IthacaFirewalks.com🔥
See an overview of the event at: https://www.youtube.com/watch?v=6KmisVA0nGQ

✨ Event Details: ✨

- Date: Saturday, April 5th, 7 PM
- Duration: About 3.5 hours, mostly indoors
- Location: Foundation of Light, 391 Turkey Hill Rd, Ithaca, NY
- Cost: Suggested donation $75-$100, with barter options and sliding scale from $25.
- Registration: Please fill out this form and send your donation to participate. This event caps at 40 people.

This event is led by Tony Simons, a 14-year certified firewalk instructor, author of The Integrity Dividend: Leading by the Power of your Word (Jossey Bass, 2008), and Lewis G. Schaeneman, Jr. Professor of Innovation and Dynamic Management at Cornell University.

Embrace the night as you light up your path to personal growth and collective empowerment. You will end the evening charged up, grounded, and very ready to take on life’s challenges. And you might change your life. This isn’t just an event; it’s a celebration of who we are. Come, let’s walk through fire together.

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There is a suggested donation of $75-$100, with barter options and need-based sliding scale from $25. Funds go directly towards firewalk materials and the Foundation of Light. Please select the payment method you intend to use below. Venmo/Paypal are strongly preferred, but please contact tony.simons@cornell.edu if you need another option.
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Venmo: @tony-simons-6 (last 4 digits of phone: 1091)

Paypal: @ithacafirewalk

Other:

Please list below how much you intend to contribute via the payment method listed above.
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The 'Courage to Be Yourself' workshop will be a transformative and growthful process and you will be guided and supported along the way by a formally trained firewalker, but there are still some risks and we require a signed liability waiver from each participant. You have the option to provide that information and digital signature here or request a paper copy to sign at the event.

We are committed to protecting the privacy and security of legal identity information we collect for participants at our event. A current state/government/tribal ID is necessary for processing liability waivers and verifying identity. We limit our data collection to what is required for these purposes and safeguard it in a secure environment, accessible only to authorized personnel. Your personal information is exclusively used for event registration and will not be shared externally without your explicit consent. You will be required to show this ID to the facilitators at the event (Tony Simons) to confirm your legal identity for the liability waiver, but we will call you by your preferred name.

I understand that my legal name and ID number are required for liability waiver purposes and I will fill out all sections below and provide my legal name and ID number as my LEGALLY BINDING SIGNATURE

I understand that my legal name and ID number are required for liability waiver purposes and I am requesting a PAPER copy of the following liability waiver to provide my legal name, ID number, and physical signature at the event before it begins

Firewalking Liability Release Form And The Assumption of Risk

I understand that my participation in this Firewalking Seminar 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 Tony Simons, the Foundation of Light, and all subsidiaries and affiliates, and any and all shareholders, officers and directors, employees or volunteers completely harmless of all liability if I sustain any injuries. By signing this waiver I attest that I am over 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 Firewalking Seminar. I acknowledge that I have been told 1) people have been seriously injured by participating in Firewalking seminars, 2) that there is in fact an inherent risk in Firewalking, and 3) if I voluntarily choose to Firewalk, there is a possibility I myself 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 Firewalking Seminar from the responsibility for any damages suffered by me, physical, mental, or financial. I understand fully that I am responsible for all my choices during the seminar and that I have the right to refuse participation at any time during the seminar. I have been told that drug or alcohol consumption before this event is dangerous, highly discouraged and must be postponed until after the event. I am physically sound of mind and body to participate in the Firewalking Seminar. I have no physical conditions which inhibit healing such as diabetes, auto immune diseases, or other medical conditions which might adversely affect my physical well being in the event of receiving a burn. I affirm that I do not desire to inflict harm upon myself. I further release any claim for a “slip and fall” injury and all other injuries and claims I may have while attending the Firewalk seminar. I am knowingly and voluntarily signing this release form and I am assuming all risks of injury including death.

I understand and I agree that this agreement shall be binding upon me and my heirs, legal representative and assigns.

Consent Form for Use of Voice, Name, and Likeness

Thank you for joining our event! By signing this form, you allow Ithaca Firewalks, Tony Simons, the Foundation of Light, and their related groups to use your voice, name, and image, as recorded at our activities or interviews. We may use your likeness in promotional materials like videos, websites, or print, without compensation. This helps share and highlight the empowering experiences of our events.

Opt-Out Option: If you wish not to be recorded or photographed, simply wear a red wristband provided at the event to indicate your non-consent.

We value your participation and respect your choices. For any questions, please contact us.

I understand that I may be photographed unless I wear a red wrist band to opt out

Please write your legal name below to indicate that you have read and understand everything contained in this waiver and assumption of risk form.

Please provide an ID number below, tell us which kind it is (driver's license, state ID, passport, tribal ID, etc.), and bring this form of ID to the event to confirm your legal identity for the liability waiver.

Would you like to be added to the Ithaca Firewalks email listserv?

Yes, please add me to the list!

Thank you for filling out this registration and waiver! If you have any questions or comments you would like us to know ahead of time, please feel free to write them below. See you at the firewalk!

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