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Waiver for all online or in person training, classes, workshops, and events with Ariel Xenia. 

In consideration of the services of Nashville Pole, LLC (DBA Ariel Xenia), their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release and discharge Nashville Pole, LLC, on behalf of myself, my children, my parents, my heirs, assigns, person representative and estate as follows:

1. I acknowledge that the activities involved in the use of any of Nashville Pole, LLC's services or facilities entail significant risks, both known and unknown, which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. 

2. I expressly agree and promise to accept and assume all of the risks existing in these activities, both known and unknown, whether caused or alleged to be caused by the negligent acts or omissions of Nashville Pole, LLC. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. 

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Nashville Pole, LLC from all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Nashville Pole, LLC equipment and facilities including any such claims which allege negligent acts or omissions of Nashville Pole, LLC. 

4. Should Nashville Pole, LLC or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume - and bear costs of - all risks that may be created, directly or indirectly, by any such condition. 

6. I agree to abide by the rules of the facility. 

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found a court of law to have waived my right to maintain a lawsuit against Nashville Pole, LLC on the basis of any claim from which I released them herein. 

I have had sufficient opportunity to read this entire document. I have read and understand it, and I agree to be bound by its terms. 

May 18, 2021

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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