MISS POLE  
Studio Release

Miss Pole Studio Release Agreement
In consideration of participating in health or fitness club activities, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence MISS POLE, LLC  and its owners, directors, officers employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:

1. I acknowledge that health or fitness club activities involve known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, musculoskeletal injuries, broken bones, and/or overuse injuries, injuries caused by equipment that breaks or otherwise fails; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment and protocol, without jeopardizing the essential qualities of the activity. 

2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, I will immediately discontinue participation.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

4. I irrevocably grant Releasees the right to use my images, and waive my right to inspect or approve images, if taken within a Miss Pole, Inc. location, in all forms and media including composite or modified representations for all purposes, including advertising, trade, or any commercial purpose throughout the world and in perpetuity. I discharge Releasees, in advance, from any and all liability including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright arising out of or connected in any way with my participation in said activity.

5. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume—and bear the costs of—all risks that may be created, directly or indirectly, by any such condition.0

6.  I acknowledge that if I am, or may be, pregnant I will consult my physician and obtain his/her consent to participate in these health or fitness club activities PRIOR to participating in any activities at MISS POLE LLC.

7.  I acknowledge I am 18 years of age or older and can provide legal proof upon request.  By signing below I confirm I am of legal age to consent liability.  I understand that I will not be refunded for any services not rendered due to my age.

8. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees’ facility is located, and I further agree that the substantive law of that state shall apply.

9. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain.

Miss Pole Studio Release Agreement

e-signature: *
(first and last name)
I, certify that I have read the above 
Miss Pole Release Agreement, in its entirety, I understand it, and I agree to be  bound by its terms and conditions.

e-signature Date: *
Contact Phone Number: *
Contact Email Address: *  
Studio Location: *
Class or Party Details:


Miss Pole, Inc. Parental Consent And Informed Consent Waiver

This agreement must be completed by the parent or legal guardian of all participants under the age of 18, who desire to attend fitness offerings at Miss Pole, Inc. This form must be completed and no exceptions will be made.

The undersigned user’s parent or legal guardian hereby agree to release and discharge from liability arising from negligence MISS POLE, LLC  and its owners, directors, officers employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of user’s parent or legal guardian and children, parents, heirs, assigns, personal representative and estate, and also agree as follows:

The user’s parent or legal guardian hereby acknowledges and that health or fitness club activities involve known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, musculoskeletal injuries, broken bones, and/or overuse injuries, injuries caused by equipment that breaks or otherwise fails; medical conditions resulting from physical activity; and damaged clothing or other property. User’s parent or legal guardian further understands such risks simply cannot be eliminated, despite the use of safety equipment and protocol, without jeopardizing the essential qualities of the activity.

The user’s parent or legal guardian further expressly accepts and assumes all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. The User’s participation in this activity is purely voluntary and the user elects to participate despite the risks. In addition, if at any time the user believes that event conditions are unsafe or the user is unable to participate due to physical or medical conditions, then the user will immediately discontinue participation.

User’s parent or legal guardian voluntarily releases, forever discharges, and agrees to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with users participating in this activity, or users use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, the user’s parent or legal guardian agrees to indemnify and hold them harmless for all such fees and costs.

The user’s parent or legal guardian has adequate insurance to cover any injury or damage the user may suffer or cause while participating in this activity, or else the user’s parent or legal guardian agrees to bear the costs of such injury or damage to the user. User’s parent or legal guardian further represent that user has no medical or physical condition which could interfere with users safety in this activity, or else User’s parent or legal guardian is willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.

The user’s parent or legal guardian acknowledges that if the user is, or may be, pregnant user’s parent or legal guardian will consult the user’s physician and obtain consent to participate in these health or fitness club activities PRIOR to participating in any activities at MISS POLE, Inc.

The user’s parent or legal guardian represents and warrants to Releasees that the parent or legal guardian is of lawful age (18 years old or older) and otherwise legally competent to sign this Waiver and Release. User’s parent or legal guardian understands that the terms of this Waiver and Release are legally binding and certifies that signing this Waiver and Release is of their free will, having carefully read and understood the terms. User’s parent or legal guardian understands that Releasees is permitting the user to use the Facilities in reliance upon the binding effect of this Waiver and Release and upon User’s parent or legal guardian representation and warranties contained in this Waiver and Release.  In the event that the user’s parent or legal guardian files a lawsuit, the user’s parent or legal guardian agree to do so solely in the state where Releasees’ facility is located, and the user’s parent or legal guardian further agree that the substantive law of that state shall apply.

Miss Pole, Inc. Parental Consent And Informed Consent Waiver


Full Name of Parent or Guardian:    
Full Name of Minor Child:                           
Full Address:  
Phone:  
Email:  
Studio Location: *
e-signature: (first and last name)    I, certify that I have read the above Miss Pole Parental
Consent Waiver, in its entirety, I understand it, and I agree to be bound by its terms and conditions.

e-signature Date: *
Class Details/Comments: