Online pole disclaimer

Health and Safety Notice and Disclaimer

Please read complete this form before your class starts.

Pole dancing can be physically strenuous.  It is unsuitable for people who suffer from neck or back problems.  Pole dancing is unsuitable if you are pregnant.  It is mandatory that any relevant medical condition is stated prior to participation.

Students with little or no dancing experience are welcome, as are experienced dancers

There is no upper age limit.  Pink Kitten Dance School requests that all students are over 18.

By completing this form I confirm that I am over 18 years of age. If you are under 18 please contact the office – we do accept applications from under 18’s but we need to discuss options with you.

Please do not consume alcohol before coming to lessons.

When taking up any new sporting activity where friction occurs, some bruising may result.  This is possible and likely especially at the beginning when learning pole dancing.

Pole dancing is a fantastic all over body workout; however, most people find that it takes a couple of weeks for your body to adapt to supporting weight on parts of your body where you wouldn’t normally support weight, for example, the back of your knees, or the inside of your thighs.

Please read the points above and confirm you agree to the points below by completing and submitting the form below.

  • I am aware of the possibility of bruising or injury due to the nature of pole dancing
  • I do not have a reason to believe that I have any medical conditions which makes pole dancing an unsuitable activity for me.
  • I am aware that pole dancing is not a suitable activity for anyone that is pregnant. I confirm I am not pregnant.
  • I understand that whilst every effort is taken to ensure my safety during the lessons, pole dancing is a sport like any other and there is always a possibility of getting hurt.
  • I confirm that I am over 18 years of age
  • I understand that if injuries  do occur, it is my responsibility and not the responsibility of Pink Kitten or my instructor. I will not hold either party responsible.
  • I have read and understood the terms and conditions.
  • I agree to listen to and abide by the instructions issued by my instructor at all times
  • I agree not to invert without the supervision and permission of my instructor and before i have learnt spotting and dismount techniques.

Your details are confidential and are for our records only.  Please rest assured that your details will not be passed on to any third parties. They are used by us to ensure the records we hold are up to date and that we can contact you/ next of kin in the event of an emergency

Please Complete Below (if you do not complete this form before your class you will be asked to complete one at your first lesson)

By completing this form you agree that you have read and understood the terms.

I confirm that I am over 18 years of age. If you are under 18 please contact the office - we do accept applications from under 18's but we need to discuss options with you.

Your Full Name (required)

Your e-mail (required) please check it is correct

Telephone to contact you on

Todays Date

Lesson you have signed up for i.e Wednesday beginners

Date Pole Course starts

Next of Kin

Contact details for next of Kin

Are you generally in good health?
yesno

Pole Dancing is unsuitable if you are pregnant. Are you pregnant
YesNo

Do you have any medical condition that we should know about? (eg: neck, back, or joint problems, heart condition, stroke, epilepsy). If yes please expand below.
YesNo

Has your doctor advised that you should not undertake a vigourous exercise regime? If yes please expand below.
YesNo

Do you suffer from vertigo or dizzy spells?
YesNo

If you have answered yes to any of the questions above we will be in contact to discuss.

Sorry but due to huge! amounts of spam we need to make sure you are a real person