Waiver

Waiver And Release of Liability

Please complete the digital form below before booking your class or event.

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Step 1 of 5 Participant Info

Let’s start with you

Enter the participant’s details exactly as they should appear on the waiver record.

Full Legal Name *

Email Address *

Confirm Email Address *

Phone *

Street Address

City

State

Zip Code

Date of Birth

Emergency contact

This helps the studio contact someone if an emergency occurs during class or an event.

Emergency Contact Name

Emergency Contact Phone

Relationship

Anything the instructor should know?

Agreement terms

Please read the full waiver carefully before continuing.

Whip It Flirty Girl Fitness & Pole Dance

ACKNOWLEDGEMENT OF RISK

I understand that participation in pole dancing classes, twerk classes, fitness classes, stretching classes, dance instruction, and related physical activities at Whip It Flirty Girl Fitness & Pole Dance involves physical exertion and inherent risks, including but not limited to slips, falls, injuries, muscle strains, bruising, soreness, physical contact with equipment, and other risks associated with physical fitness activities.

I voluntarily choose to participate and fully assume all risks associated with participation.

MEDICAL STATEMENT

I certify that I am physically capable of participating in fitness, pole dance, twerk, and dance-related activities. I understand it is my responsibility to consult a physician before participating if I have any medical conditions, injuries, or concerns.

I agree to immediately stop participation and notify the instructor if I experience pain, dizziness, discomfort, or any medical issue during class.

RELEASE OF LIABILITY

In consideration for being allowed to participate in classes and activities at Whip It Flirty Girl Fitness & Pole Dance, I hereby release, waive, and discharge Whip It Flirty Girl Fitness & Pole Dance, its owners, instructors, employees, contractors, agents, and affiliates from any and all liability, claims, demands, actions, damages, costs, or expenses arising from injury, loss, or damages related to participation in classes or use of the facility.

This release applies to negligence to the fullest extent permitted by Illinois law.

STUDIO RULES

Follow all instructor directions and studio rules.
Wear appropriate attire for classes.
Do not participate while under the influence of drugs or alcohol.
Respect studio equipment and other participants.
Understand that no refunds are guaranteed unless approved by management.

I acknowledge and accept the risks associated with participation.

I certify that I am physically capable of participating and will stop if I experience pain, dizziness, discomfort, or a medical issue.

I agree to the Release of Liability terms stated in this waiver.

I agree to follow all studio rules and instructor directions.

Photo release

Please choose one option. This question is required.

Do you give permission to Whip It Flirty Girl Fitness to use your photo/videos for promotional purposes only? *

Yes, I give permission. No, I do not give permission.

Final signature

Type your full legal name below. This will be saved with your Waiver ID and submission timestamp.

I have carefully read this Waiver and Release of Liability and fully understand its contents. I voluntarily agree to its terms.

I understand that by typing my full legal name below, I am electronically signing this waiver and agreeing to its terms.

I confirm that I am at least 18 years old or have permission from a parent/legal guardian if required by the business.

Typed Signature *

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Your Waiver ID will be shown on screen after submission and emailed to the address you provide.

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Waiver Submitted

Your waiver has been submitted successfully. Copy your Waiver ID and enter it in the Acuity booking form.

Your Waiver ID

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A confirmation email with this Waiver ID has also been sent to the email address you provided.