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Liability Waiver and Release Form

Participant information

Full legal name

Date of birth

Email

Phone

Emergency contact

Contact name

Contact phone

Medical information

Relevant medical conditions or allergies

Media release (optional)

Untitled checkboxes field

I grant permission for photos/videos taken during activities to be used for promotional purposes.

Risk acknowledgment

I understand and acknowledge that participation in the selected activities involves inherent risks, including but not limited to:

Falls from height resulting in serious injury or death

Muscle strains, sprains, and overexertion injuries

Bruising and skin abrasions from pole contact

Equipment failure or malfunction of poles and apparatus

Injuries from contact with other participants or equipment

Aggravation of pre-existing medical conditions

I acknowledge that pole and aerial fitness require physical strength, flexibility, and coordination. I voluntarily assume all risks associated with my participation and agree to release and hold harmless the business, its owners, instructors, employees, and host studio or venue from any and all liability and claims that may result from my participation in pole and aerial fitness activities.

I acknowledge that I have read and understand the specific risks of pole dancing and aerial fitness and voluntarily assume all risks of participation. I understand that I must follow all safety rules and instructor guidance, and that I participate at my own risk.

By signing this agreement, I agree to hold the company completely harmless, including financial responsibility for any injuries sustained, regardless of the cause or circumstances.

I will do all in my power to obey staff and all safety requirements, and I will seek clarification if necessary.