POLE PLACE WAIVER
PRE-STUDIO ATTENDANCE FORM

We’re looking forward to welcoming you to Pole Place. Before attending your first class or practice session, please complete this form so we can help ensure a safe, clear, and positive experience for everyone.

Please read and complete all sections carefully. Submission of this form is required before attending the studio.

YOUR OWN DETAILS:

If the participant is aged 16–18, this form must be completed by a parent or legal guardian.

Full Name

Phone

Date of Birth required

YOUR EMERGENCY CONTACT DETAILS:

Emergency Contact Full Name

Emergency Contact Phone Number

HEALTH & PERSONAL RESPONSIBILITY

Pole dance fitness is a physically demanding activity. By attending classes or practice sessions at Pole Place, you confirm that:

You are responsible for knowing your own physical and mental limits
You will inform Pole Place instructors of any medical, physical, or psychological condition that may affect your ability to participate safely
If you have any health concerns, are pregnant, or are recently postnatal, you will seek appropriate medical advice before attending sessions

PRACTICE SESSIONS

Where applicable, you understand that:

Practice sessions are unsupervised and untutored
They are intended solely for independent self-practice
Participation is entirely at your own risk
You are strongly advised to hold appropriate personal insurance

WAIVER & RELEASE OF LIABILITY

You understand that pole dance fitness involves inherent risks, including the risk of injury.

You voluntarily choose to participate in classes, private sessions, and/or practice sessions offered by Pole Place Limited and Pole Place Horsham Limited, and you do so at your own risk.

To the fullest extent permitted by law, you agree for yourself and anyone entitled to act on your behalf to waive, release, and discharge Pole Place Limited and Pole Place Horsham Limited, including their owners, instructors, employees, contractors, and representatives, from any liability, claims, or demands arising from or connected with your participation in sessions or from general advice provided by instructors or via the Pole Place website, except where liability cannot be excluded by law.

TERMS & PRIVACY ACKNOWLEDGEMENT

You understand and agree that:

Booking, cancellation, refunds, memberships, credit packs, and media consent are governed by the Pole Place Terms & Conditions, which you have reviewed and agreed to separately via the Pole Place app or website
Personal data is collected and processed for booking, safety, and communication purposes in accordance with the Pole Place Privacy Statement
Personal data is only shared with trusted service providers where necessary (such as booking and payment platforms)

FINAL DECLARATION & CONSENT

I confirm that I have read and understood all of the above and agree to this Pre-Studio Attendance Form, including the Waiver & Release of Liability. I understand that this forms a legally binding agreement.

Name of Participant / Parent or Legal Guardian:

Date Signed required

Thanks for submitting!
We look forward to welcoming you along to the studio soon!