Alcohol and Release of Liability Form

ALCOHOL POLICY:
Here at Pole Control Studios, we do not sell or serve alcoholic beverages. We will allow you to bring
in alcohol, under the circumstances, that we will not be held accountable for any injuries sustained
while under the influence of alcohol. By signing below, you agree that you will be held accountable
for any and all injuries sustained here at Pole Control Studios and that you participate at your own
risk.

I ________________________________________________________acknowledge the above

information is true and correct. I have read and accept the terms, conditions, class policies, alcohol
policy, fees and charges of Pole Control Studios Party Planners. I waive and release any and all
claims whatsoever arising from my participation in Pole Control Studios Parties, Events or Services.

READ CAREFULLY
THIS IS A WAIVER AND RELEASE OF LIABILITY
Whereas, (“Participant”) has a desire to participate in classes at the Pole Control
Studios. Whereas, Participant fully understands the risks involved in that it is
possible to sustain serious injury during the class, course or workshops of said
studio; and
NOW, THEREFORE, in consideration of the opportunity to participate in the
aforementioned class, Participant agrees as follows:
1. I hereby release, waive and discharge Pole Control Studios, Sam Cohen Realty
75 Pratt st, the members, agents and employees (collectively, “Releasees”), from
all liability to me and to my conservators, guardians or other legal representatives,
assigns, heirs and next of kin for any and all claims, demands, losses or damages on
account of any injury, death, or damaged property, arising out of my class(es) or
party(es). I understand that Sam Cohen Realty does not endorse or support the
classes or parties.
2. I hereby release, waive and discharge the Releasees from all liability to me and
my conservators, guardians or other legal representatives, assigns, heirs and next
of kin for any and all claims, demands, losses or damages on account of any injury,
death, or damaged property, arising out of any negligence relating in any way to the
class(es) or party(es).
3. I also hereby agree to indemnify and hold harmless the Releasees from any claim
or demand on account of injury or damage which I may suffer as a result of the said
class or party.
4. I understand that this release, waiver and agreement to indemnify and hold
harmless includes, but is not limited to, damages which are caused, or alleged to be
caused, in whole or in part by the negligence of the Releasees.
5. I understand that my class is done on a purely voluntary basis. I understand that
a class or party can, in some cases, cause injuries, and, in some cases, cause
potentially severe injuries. I am familiar with the potential risks involved in the
class or party and I assume all such risk.
6. I acknowledge that I have the opportunity to inspect the equipment, facilities,
and either have done so or will do so, and I hereby waive any claim I may have with
respect to the use, design or operation of the equipment or facilities that I may use.
7. The numbered paragraphs of this Release and Waiver of Liability are severable.
8. I have read the above agreement and release of waiver and liability and
understand that by signing it I have given up substantial rights. I sign this
agreement voluntarily.

(signature) (date)
(printed full name)