Pole Free Waiver
Emails collected for this waiver are for the sole purpose of communication related activities/events are not for marketing or solicitation purposes.
Email *
Full Legal Name *
In consideration of permission to use today, and on all future dates, the property, facilities, staff, equipment, and services of On The Pole, LTD, it's agents, owners, officers, volunteers, participants, contractors, employees, and all other persons or entities acting in any capacity on their behalf (herein collectively referred to as “Pole Free”), and in consideration of the services provided by Pole Free, I, the above named, agree to release, indemnify, and discharge, Pole Free, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows: 1. ASSUMPTION OF RISKS: I acknowledge that my participation in activities (including but not limited to pole dance, dance) and other activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: slips and falls, falling from equipment, pole burns, negligence of other people, my own physical condition, pinches, scrapes, twists and jolts, scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards and even death. If injured, you may require medical assistance, at your own expense. Furthermore, Pole Free may be unaware of your injury, fitness level, or abilities, may give incomplete warnings or instructions, and the equipment being used might malfunction or fail. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. 2. INDEMNIFICATION: I hereby voluntarily release, forever discharge, and agree to indemnify and hold Pole Free harmless from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity, my use of Pole Free’s equipment or facilities, and/or participation in events where I am supplying my own equipment, including any such claims which allege negligent acts or omissions of Pole Free. Should Pole Free 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 cost and to reimburse them for any such expenses. 3. INSURANCE: I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. 4. SEVERABILITY: I further expressly agree that the foregoing agreement and assumption of risk is intended to be as broad and inclusive as is permitted by the law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in the activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Pole Free on the basis of any claim from which I have released herein. I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name. *
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