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Pole & Fitness Liability and Health Waiver
 

While training at BELLA ROSE POLE FITNESS LLC:

 

I understand that physical exercise can be strenuous and subject to risk of serious injury. You are urged to obtain a physical examination from a doctor before participating 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 I engage in any physical exercise or activity, I do so entirely at my own risks.

 

This waiver and release of liability includes, without limitation, all injuries which may occur as a result of:

 

(a) Your participation in any activity or training session and

 

(b) Instruction, training, supervision by your instructor while at BELLA ROSE POLE FITNESS LLC.

 

You acknowledge that you have carefully read this "waiver and release" and fully understand that it is a release of liability. You expressly agree to release and discharge the Instructor at BELLA ROSE POLE FITNESS; fitness from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against your Dance/Pole Instructor for personal injury or property damage.

 

To the extent that statute or case law does not prohibit release for negligence, this release is also for negligence on the part of the Dance/Pole Instructor. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to the invalid, then the remained of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from.

 

By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.

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Do you have or ever experienced the following? (Please select relevant answer)
Diabetes
Epilepsy
Chest pains brought on by physical exertion
Chest pains brought on by physical exertion
Dizziness or fainting
A bone, joint or muscular problem or arthritis
Asthma or other respiratory problems
Any sustained injuries or illnesses
Any allergies
Are you taking any medication
Has anyone in your family had a heart problem?
Is there any chance that you could be pregnant?
Have you been in hospital over the last 6 months?
NOTE: You may occur bruises due to the nature of the fitness. Physical spotting will occur during the classes. Pictures may be taken during the class for social media purposes. I grant permission.

See you soon! 

Red Wall & Stairs

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