Partipole is a group fitness pole dancing lesson designed for apparently healthy adults. 

I also have been advised that the consumption of alcohol before or during the lesson is not
recommended and that any injury caused to myself or others as a result of this is solely
my responsibility.

I have no medical history that prevents me from taking part in any physical activity, I am not
pregnant or have had a baby in the last 6 weeks and do not know of any other reason why I
should not take part.

Due to the nature of this type of exercise I may experience some slight bruising or chaffing
from the pole and understand that Partipole accept no responsibility for any injury sustained
as a result of me taking part in this lesson.

I understand that I am taking part in this Partipole lesson voluntarily and I do so entirely at my
own risk, I am over 18 years of age and am not part of the Respect (youth inclusion) project.

Name:

Address:

Phone number:

Signature:

Date:

Please print, read and sign then hand this to your Partipole instructor before taking part, thank you