By checking this box, I agree to the waiver of liability.
RELEASE, WAIVER AND INDEMNITY AGREEMENT and AGREEMENT TO ASSUME RISK
OF POTENTIALLY HAZARDOUS ACTIVITY
For good and valuable consideration (value), the receipt and sufficiency of which is hereby
conclusively acknowledged, including being permitted to enter an event venue holding a
performance or competition sanctioned by Pole Sport Organization LLC, or any other location,
(the “Event Venue”) for any purpose, including but not limited to observation, use of facilities or
equipment, or participation in any way, including training, performing, volunteering, judging,
and/or competing in pole dance and/or lyra and/or silks, (collectively “the Aerial Arts”, which is a
potentially hazardous activity):
The undersigned hereby acknowledges, agrees and represents that he or she, immediately
upon entering, will inspect such Event Venue and facilities. It is further warranted that such entry
in the Event Venue for observation, participation or use of any facilities or equipment is an
acknowledgment that such Event Venue, and all facilities and equipment inside have been
inspected, and that the undersigned finds and accepts same as being safe and reasonably
suited for the purposes of such observation or use.
In further consideration of being permitted to enter the Event Venue for any purpose, including
but not limited to observation, use of facilities or equipment or participation in any way, including
the Aerial Arts, the undersigned hereby agrees to the following:
THE UNDERSIGNED HAS OBTAINED OR WILL OBTAIN AN APPROPRIATE MEDICAL
CHECKUP, BEFORE COMMENCING ANY AERIAL ARTS TRAINING, WITH A PHYSICIAN TO
VERIFY THAT AERIAL ARTS TRAINING IS APPROPRIATE FOR THE UNDERSIGNED’S
PHYSICAL CONDITION. IF THE PHYSICIAN DISAPPROVES OR APPROVES BUT ONLY
SUBJECT TO CERTAIN CONDITIONS, THE SAME SHALL BE COMMUNICATED IN
WRITING TO POLE SPORT ORGANIZATION LLC AS A PRECONDITION TO ENROLLING IN
PERFORMANCE, COMPETITION, CLASS, OR TRAINING.
THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT
TO SUE POLE SPORT ORGANIZATION LLC, and any of their officers, directors, instructors,
employees, agents, and co-participants (hereinafter referred to as “Releasees”) from all liability
to the undersigned for any loss or damage, and any claim or demands on account of injury to
the person or property or resulting in death of the undersigned, whether caused by the
negligence, pre-existing medical condition, or physical over-exertion of the undersigned or
otherwise, while the undersigned is in, upon or about the Event Venue or any facilities or
equipment. This includes without limitation injuries or damages which may result from physical
contact with participants or instructors, slipping or tripping and falling due to a dangerous
condition of the property, improper maintenance of the Event Venue or equipment, inadequate
security, inadequate supervision, and/or improper or negligent instruction.
THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS
THE RELEASEES and each of them from any loss, liability, damage or cost they may incur due
to the presence of the undersigned in, upon or about the Event Venue or in any way observing
or using any facilities or equipment of at the Event Venue, whether caused by the negligence of
the Releasees or otherwise.
THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF
BODILY INJURY, death or property damage due to the negligence of Releasees while in, upon
or about the Event Venue or while using the Event Venue or any facilities or equipment hereon.
THE UNDERSIGNED FURTHER EXPRESSLY AGREES THAT THE FOREGOING RELEASE,
WAIVER AND INDEMNITY AGREEMENT AND AGREEMENT TO ASSUME RISK OF
POTENTIALLY HAZARDOUS ACTIVITY IS INTENDED TO BE AS BROAD AND INCLUSIVE
AS IS PERMITTED BY THE LAW OF THE STATE OF CALIFORNIA and that if any portion
thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal
force and effect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER
OF LIABILITY AND INDEMNITY AGREEMENT AND ASSUMPTION OF RISK OF
POTENTIALLY HAZARDOUS ACTIVITY, AND FURTHER AGREES THAT NO ORAL
REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING
WRITTEN AGREEMENT HAVE BEEN MADE. FURTHERMORE, THE UNDERSIGNED
UNDERSTANDS THAT NO ONE AT AN EVENT VENUE IS AUTHORIZED TO MODIFY THIS
I fully understand that if any medical treatment is provided to me, with or without my consent,
such treatment will be first aid type treatment, and I waive any and all claims or causes of action
arising from or based upon the provision of such treatment, including claims or causes of action
based upon the negligent provision of such treatment.
By participating in or attending any activity in connection with Pole Sport Organization LLC,
whether inside or outside the Event Venue, I consent to the use of any photographs, pictures,
film or videotape taken of me or provided by me for publicity, promotion, television or any other
use, and expressly waive any right of privacy, compensation, copyright or other ownership right
connected to same.
No amendment, modification, or supplement to this Agreement shall be binding unless it is in
writing and signed by the parties. This Agreement is the entire agreement between the parties.
This Agreement supersedes all previous agreements. If any term or provision of this Agreement
is determined to be illegal, unenforceable, or invalid in whole or in part for any reason, such
provisions shall be stricken from this Agreement, and shall not affect the legality, enforceability,
or validity of the remainder of this Agreement. Each person signing this Agreement represents
and warrants that he or she is duly authorized and has legal capacity to execute and deliver this
Agreement, including the parents or guardians of any minor. This agreement shall bind the
parents, heirs, executors and assigns of the undersigned.
I HAVE CAREFULLY READ THIS RELEASE. I HAVE NO QUESTIONS TO ASK PRIOR TO
SIGNING THIS AGREEMENT. THIS IS A LEGAL DOCUMENT AND I HAVE HAD THE
OPPORTUNITY TO CONSULT MY ATTORNEY BEFORE SIGNING IT. I AGREE THAT ANY
AMBIGUITY IN THIS AGREEMENT SHALL NOT BE INTERPRETED AGAINST POLE SPORT
ORGANIZATION LLC WHO WROTE IT.
Signing this agreement shall apply to all performances or competitions sanctioned by Pole Sport
Organization LLC during calendar year 2019.