Waiver of Liability and Assumption of Risk Agreement

Pole Bait LLC

I hereby acknowledge and agree to the following terms and conditions before participating in a pole fitness coaching session with an Independent Contractor at Pole Bait LLC. Please read this document carefully before signing.

Assumption of Risk: I understand that physical exercise, particularly in the context of pole fitness, can be strenuous and may pose a risk of serious injury. I acknowledge that I am encouraged to seek a physical examination from a qualified physician before engaging in any exercise activity.

I recognize that such physical activity and exertion may be difficult and strenuous and may cause or aggravate a physical injury or medical condition. I agree that, by engaging in any physical exercise or activity, I do so entirely at my own risk.

Release of Liability: I understand and voluntarily accept all the risks associated with participating in any activity or training session and receiving instruction, training, and supervision by my instructor while at Pole Bait LLC.

I hereby release and discharge Pole Bait LLC, its Independent Contractors, and the Dance/Pole Instructor (referred to as "Instructor") at Pole Bait LLC from any and all claims or causes of action arising from or related to my participation in the private coaching session. I willingly give up or waive any right I may otherwise have to bring a legal action against the Instructor for personal injury or property damage.

This release also extends to any potential negligence on the part of the Instructor or Pole Bait LLC.

Severability: If any part of this release from liability is deemed invalid by a Court of competent jurisdiction, the remaining provisions shall remain in full force and effect. The offending provision will be severed from the agreement.

By signing this release, I acknowledge that I have carefully read and fully understand its content. I also acknowledge that this release cannot be modified orally.

Name

First Name

Last Name

Email

Phone

(###)

###

####

I certify that I am 18 years of age or older

Yes, I am 18+

EMERGENCY CONTACT

First Name

Last Name

Emergency contact phone number

electronic signature consent

add your initials here*

By checking here, you are consenting to use of your electronic initials in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead which we can have ready for you at your next studio visit. After consent, you may request a digital or paper copy of this waiver for your records. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. *

I understand the terms, and give my consent.

Want a paper copy?

Print Waiver Form

Be sure to sign our Waiver & release form before your first session

Want a paper copy?

Pole bait