Additional Student Waiver | Pole Des Moines

Release of Liability and Waiver Agreement

This Waiver Form is to be signed only by Additional Students only.

A Host's Waiver (the booking party) is to sign the Waiver form included in their booking.

This is not the Pole in the Park Waiver. Please refer to the menu for that.

Please read through carefully before agreeing and signing.

You must be 18 years or older to fill out a waiver and or to attend class without parent or guardian.

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Pole dance is rough on your body physically. Bruising, skin burns, muscle pains and aches are all a normal experience, and will get better over time. Falling can cause an aray of bodily harm, from strains, sprains, or broken limbs, concusions, and other injuries. Please be aware of the risks that come with pole dancing before starting. By completing this waiver you understand and assume all risks, including unseen risks, and acknowledge that Pole Des Moines, LLC and it's instructors are not liable for any injuries or property damage.

I am aware and assume all risks of the bodily harm Pole Dance may cause, I am responsible for any bodily injury that may occur.

I acknowledge that my safety and limitations are my responsibility alone.

I acknowledge and understand that Pole Des Moines, LLC will not be held liable or responsible for any injuries accumulated before, during or after the scheduled Private Pole Lesson.

I understand that as a participant, I am solely responsible financially for any costs towards medical treatment during or after the session.

By filling out this waiver you acknowledge and understand that you will be using either the Host's pole, or equipment provided by Pole Des Moines, LLC.

Pole Des Moines, LLC does -NOT- install or set up home poles, and is not liable for any damages or injury due to improperly installed home poles.

I acknowledge that any pole equipment provided in this session is to be respected and any injuries to myself or to or others due to lack of proper handling will be my responsibility. I understand that any damages to equipment due to improper handling is my responsibility and I may be charged for any damages. Pole Des Moines LLC, is not held liable for any damages to or from any Pole equipment used.

I acknowledge that Pole Des Moines, LLC and Pole Des Moines, LLC's Pole instructor are not liable or responsible for any injury that occurs on or off the pole provided by the Host (the booking party). And that the installation and maintenance of the pole are the Host's responsibility alone.

I understand and agree that any misuse or improper handling resulting in damages by me, of any equipment provided by Pole Des Moines, LLC will be charged back to me and I will be responsible in paying for any damages.

I understand and agree I will be responsible in reimbursement towards any legal fees, settlements or damages incurred.

I understand that this is a legally binding contract and I have read through the Release of Liability and Waiver Agreement carefully and adhere to everything listed above.

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