Waiver Form | Love Life Pole

Release of Liability Waiver

Legal First Name

Legal Last Name

Phone

Do you have any medical conditions that would prevent you from being able to participate in intense physical activities?

Yes

Please specify anything we should know about (e.g. medical limitations or health related illnesses)

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Non-Solicitation You agree not to divert or attempt to divert business from Love Life Pole. Solicitation of customers to outside service providers for services including but not limited to: pole fitness or dance classes, private pole fitness or dance lessons, promoting pole fitness or dance studios offering similar services in direct competition. will result in removal from Love Life Pole.

Your Signature

PARENT SIGNATURE REQUIRED FOR CLIENTS UNDER 18 YEARS OF AGE

I declare that the info I’ve provided is accurate & complete.

Drivers License or ID

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