Welcome to

pole dolls dance studiO!

To register to our studio, please fill out the following form

First Name

Email Address

In Case Of Emergency Contact

Last Name

Contact Number

Emergency Contact Number

Have you attended any pole and aerial classes before? If yes, where?

What are your fitness goals?

Have you lost your consciousness in the last past 12 months?

Yes

Have you recently had surgery?

Yes

Do you have or have had any bone or joint problems?

Yes

Are you pregnant, or have given birth in the last 3 months?

Yes

Waiver

I, the undersigned, have voluntarily enrolled in Pole Dolls Dance Studio. I acknowledge that I have enrolled in a program of strenuous physical activity including, but not limited to, pole dancing, extreme stretching, body conditioning and inversion practice. I hereby agree to release and discharge Pole Dolls Dance Studio in connection with any activity herein. I hereby affirm that I am in good physical condition, do not suffer from any disability that would prevent or limit participation in any exercise program, and have been infirmed that I should consult a physician before beginning this or any other exercise program.

I understand that any exercise activity I undertake with Pole Dolls Dance Studio bears certain risks which could result in injury or damage, including, but not limited to, physical injury to the legs, knees, back, hands, or other part of the body, or injury to or strain on the cardiovascular, circulatory and/or respiratory system.

I expressly agree and promise to accept and assume all responsibility and risk of injury, death, illness or disease or damage to myself or to my property arising from my participation in these activities. My participation in these activities is purely voluntary and I am electing to participate in spite of these risks.

By signing this voluntary release, I fully recognize that if I or anyone else is hurt or damaged while I am engaged in any activity during my session at the Pole Dolls Dance Studio, I will have no right to make a claim or file a lawsuit against Pole Dolls Dance Studio, regardless of the reason for my injury or damage.

I recognize that this release shall remain in effect as long as I continue to attend classes at the Pole Dolls Dance Studio. By signing this release, I acknowledge that I have read this entire document, understand it completely, understand that it affects my legal rights, and agree to be bound by its terms.

I have read and fully understand the waiver of liability and its contents. I voluntarily agree to the terms conditions stated above.

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