2026
WAIVER

First name

Last name

Phone

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

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EMERGENCY CONTACT NANE

RELATIONSHIP TO CLIENT

Emergency Contact Phone Number

HEALTH AND MEDICAL ACKNOWLEDGMENT

Please answer the following questions honestly and completely. This information helps Pink Cherry Pole & Dance Studio promote a safe experience. Clients are responsible for consulting a qualified medical professional when appropriate.

Do you currently have any injury, medical condition, physical limitation, or health concern that may affect your ability to participate safely?

YES

If yes, please describe the injury, condition, limitation, or health concern.

Are you currently pregnant, believe you may be pregnant, or have you recently given birth?

YES

Prefer not to answer

If yes, please provide any information or restrictions that may affect your participation.

Are you currently taking any medication or substance that may cause dizziness, drowsiness, impaired balance, reduced coordination, or otherwise affect your ability to participate safely?

YES

Prefer not to answer

If yes, please describe any safety-related effects or restrictions. Do not list medication names unless you choose to.

I agree to stop participating immediately and notify the instructor or studio staff if I experience pain, dizziness, shortness of breath, weakness, loss of balance, or any other condition that makes participation feel unsafe.

I agree

ASSUMPTION OF RISK AND PARTICIPATION AGREEMENT

I understand that participation in pole fitness, dance, stretching, conditioning, workshops, private sessions, parties, events, and the use of studio equipment involves inherent risks. These risks may include, but are not limited to, falls, bruises, muscle strains, sprains, dizziness, loss of balance, contact with poles, floors, heels, mats, or other equipment, and other physical injuries. I voluntarily choose to participate and knowingly accept and assume these risks.

I have read and understand the Assumption of Risk and Participation Agreement above, and I voluntarily accept these risks.

RELEASE OF LIABILITY

To the fullest extent permitted by law, I release and hold harmless Pink Cherry Pole & Dance Studio, LLC, its owners, directors, officers, employees, instructors, contractors, representatives, agents, volunteers, successors, and assigns from claims arising out of my participation in studio activities or use of studio equipment, including claims involving personal injury, illness, property damage, or loss, except where such release is prohibited by law.

I have read and understand the Release of Liability above, and I agree to its terms.

STUDIO RULES AND SAFETY AGREEMENT

I agree to follow all studio rules, safety instructions, and directions given by Pink Cherry Pole & Dance Studio staff and instructors. I will use poles, mats, heels, and other equipment only as instructed. I understand that the studio may refuse or stop my participation if staff believes I am acting unsafely, disrupting class, misusing equipment, or appearing impaired by alcohol, drugs, medication, or any other substance.

I have read and understand the Studio Rules and Safety Agreement above, and I agree to follow all studio rules, safety instructions, and staff directions.

EMERGENCY MEDICAL AUTHORIZATION

If I become ill or injured while participating and I am unable to make decisions for myself, I authorize Pink Cherry Pole & Dance Studio staff to contact emergency services and obtain reasonable emergency medical assistance on my behalf. I understand that Pink Cherry Pole & Dance Studio does not provide medical care and is not responsible for the cost of any emergency response, transportation, treatment, or related services.

I authorize Pink Cherry Pole & Dance Studio staff to contact emergency services and obtain reasonable emergency medical assistance for me under the circumstances described above..

PERSONAL PROPERTY AND RESULTS DISCLAIMER

I understand that Pink Cherry Pole & Dance Studio is not responsible for the loss, theft, or damage of my personal belongings, including clothing, shoes, jewelry, phones, bags, or other items brought into the studio. I also understand that individual results vary and that the studio does not guarantee specific fitness, performance, flexibility, weight-loss, or skill-development outcomes.

I have read and understand the Personal Property and Results Disclaimer above.

PHOTO AND VIDEO CONSENT

Pink Cherry Pole & Dance Studio may occasionally take photographs or video recordings during classes, parties, workshops, events, or studio activities for promotional, educational, social media, website, or marketing purposes. Your choice below will not affect your ability to participate.

Do you give Pink Cherry Pole & Dance Studio permission to photograph or record you for promotional and marketing purposes?

Yes, I give permission

No, I do not give permission

ARRIVAL, GRACE PERIOD, AND WARM-UP ACKNOWLEDGMENT

I understand that all classes begin on time and that Pink Cherry Pole & Dance Studio provides a five-minute grace period. After the grace period, the studio doors may be locked and I will forfeit my class without a refund or credit. No exceptions will be made. I also understand that clients must complete an appropriate warm-up before beginning their workout.

GOVERNING LAW AND FINAL LEGAL TERMS

This Agreement and all rights, duties, and obligations between the parties shall be governed by and interpreted solely in accordance with the laws of the State of North Carolina. Any litigation involving the parties arising from or relating to this Agreement shall be brought within the State of North Carolina and shall be subject to the jurisdiction of the courts of the State of North Carolina.In entering into this Agreement, I acknowledge that I am not relying upon any oral or written represent

FINAL ACKNOWLEDGMENT AND ELECTRONIC SIGNATURE

I confirm that I am at least 18 years of age, that I have read this waiver in full, that I understand its terms, and that I have had the opportunity to ask questions before signing. I understand that my electronic signature has the same effect as my handwritten signature.

I certify that I am 18 years of age or older and agree to all required terms contained in this waiver.

Client Electronic Signature

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Date Signed

Month

Day

Year

2026 WAIVER

2026
WAIVER