Student Release & Pole & Exotic Dance Party Release
Pole Waxers University ™
Pole Waxers University ™
 | |  | |  | |  | |  |
Student: _______________________
Class___________________Enrollment Date__________________
Level__________________________
POLE WAXERS STUDENT AGREEMENT:
Welcome to POLE WAXERS UNIVERSITY, A/K/A DIRTY SOUTH POLES, INC, WWW.HARDCOREPOLES.COM, WWW.STINKIEPINKIE.COM,
WWW.POLEWAXERSUNIVERSITY.COM (1) This Student Agreement (“Agreement”) is being entered into by you Dirty South Poles, Inc
( 2)
When you sign up for a Pole Waxers Pole Dance class, we are committing to provide you a specific time slot in a specific class with a Pole
Waxers instructor subject to the terms and conditions contained in this Agreement, thereby making this
Time slot unavailable to others. Please understand the commitment we are making to you does force us to adhere to a set of policies and
prior to being admitted to any class or other Pole Waxers activity, you must agree to the terms of this Agreement.
These policies and the other terms are outlined below and are subject to change from time to time.
Please read this Agreement carefully and ensure you understand the obligations you are undertaking before you sign this Agreement.
Section 1: Policies for class sessions, private classes, and parties
SECURING A CLASS:
To secure a time slot in a specific class, Payments must be made at any time online at www.polewaxersuniversity.com or prior to the First
Day of Class.
If full class payment is rejected through the Goggles Secure Checkout System we reserve the right to remove you from the class roster and
allow another student take your spot and your spot will be forfeited.
All references in this Agreement to “Dirty South Poles, Inc”
Or the “www.hardcorepoles.com, www.polewaxersuniversity.com or www.stinkiepinkie.com” shall mean
Pole Waxers or Pole Waxers University as well as all affiliated, related, parent and subsidiary entities.
REFUND POLICIES
Class Sessions
No refunds for class sessions will be made for any Pole Classes that have been discounted or that offer a Special Rate offer or for any of 4-
week Pole classes or Luscious Laps & Exotic Dance Class. Any other Pole Class Refunds will only be granted when requested a minimum of
15 days prior to the start of the class for which you are registered and notifying the studio where you are enrolled via email or in writing must
make ALL refund requests. Unless the
Minimum 15 day notice is given, you will not be eligible for a refund.
Medical Exception
Should you become injured or ill to the extent that participation in class is not advisable by your physician?
You may apply for a Medical Rollover of your unused classes toward a future session to be used within six months time provided your class
has been paid in full. In such cases, you must provide Pole Waxers with a written note from your physician describing your injury or illness,
relevant dates of injury or
Illness and treatment and you must sign out of class no later than 72 hours after such class was scheduled.
Failure to notify Pole Waxers within 72 hours after missing class due to said injury or illness would cause forfeiture of the possibility for a
Medical Rollover of your unused classes. Any request for medical
Exception may be granted or denied at Pole Waxers University’s sole discretion. In order to return to class, a written release from your
physician stating your ability to resume classes will be required.
Private Classes
Full payment is required to book a private class and such payment is nonrefundable. In consideration of your
Instructor’s schedule and others who may want the same time slot, 72 hours advance notice is required to
Reschedule your private class or your ability to reschedule will be forfeited. Any and all rescheduling will be at The sole discretion of Pole
Waxes University and subject to class availability.
POLE & EXOTIC DANCE PARTY
A Down Payment is required to book a party and is to be made online through our website www.polewaxersuniversity.com using Googles
Secure Checkout System and such payment is nonrefundable. The remaining balance is due in full by form of Cash Only at time of Your
Party paid at the Studio. In consideration of your Instructor’s schedule and others who may want the same time slot, 7 days advance notice
is required to reschedule your party, or your ability to reschedule your party will be forfeited. Any and all rescheduling will be at the sole
discretion of Pole Waxers University and subject to class availability.
I have read and understand the above policies. I understand that once Payments have been paid to Pole Waxers University,
There will be no refunds for classes, privates or parties scheduled, other than as expressly provided above. I understand and agree that I
am soley responsible for all of my guest. I understand and agree that it is my responsibility not to allow any quest under the age of 21 to
drink alcoholic beaverages while attending my party at Pole Waxers University.com.
____ (Initial)
OTHER POLICIES
Class Make-up Policy
For the convenience of our students we do allow students to miss any of our beginners 4 week classes, we do allow One class per session
for 6 weeks classes and Two classes missed for 8 weeks and more classes, and if you have
Notified us of your absence in advance the missed classes can be made up. Make-up classes will only be scheduled If you have cancelled
your class (either by phone or online) at least 24 hours in advance. If you do not cancel out of your class your missed class will count as
used even though you did not attend and a make-up class will no
Longer be allowed. Due to scheduling constraints, Pole Waxers will contact you on availability for make up class session.
Missed classes do not rollover to future sessions unless you remain enrolled as a student of Pole Waxers University. If you 90 days. Once a
make-up class is scheduled, if not cancelled at least 24 hours in advance, it counts as used even if not attended.
I have read and understand the above make-up policy. ____ (initial)
Safety
In the interest of safety, any individual who appears intoxicated or otherwise disruptive to the conduct of a class, Private or party may, at the
sole discretion of Pole Waxers University, be asked not to participate in class,
Forfeiting any deposits and payments made by that person for that session, private or party.
Arrival and Departure Times
We ask that you are considerate of other students and arrive a few minutes prior to your sessions’ scheduled start time. You may depart at
any time once the session has started but you cannot make up the class time
Should you choose to depart early?
Confidentiality and Non-disclosure
By signing below, you acknowledge that all class content, including but not limited to teaching method, curriculum,
Discussions, written materials, movements, dance steps, routines, choreography and scenery (the “Proprietary Information”) are the
property of Dirty South Poles, Inc and constitute confidential and proprietary business Information and trade secrets, the unauthorized
disclosure of which will irreparably harm Dirty South Poles, Inc.a/k/a Pole Waxers University.
You further agree that in exchange for Dirty South Poles, Inc agreeing to take you on as a student or Party Group, you agree to keep the
Proprietary Information confidential and that you will not disclose the Proprietary Information to anyone
Without the prior written consent of Dirty South Poles, Inc. You further agree that you will not teach to any third party any of the Proprietary
Information, and that you will refer any person wishing to learn any of the Proprietary Information to Dirty South Poles, Inc a/k/a Pole Waxers
University. You further expressly agree that you will not use the Proprietary Information for the purpose of soliciting any students/ employees
/ or Instructors of Dirty South Poles, Inc or to Otherwise compete with Dirty South Poles, Inc a/k/a Pole Waxers University.
I confirm that I am not an employee or employed with any Pole Dance Studio, Private Pole Dance Instructor or Facility in which teaches
Pole Dance, Exotic Dance or similar._______(initial)
( Please Do Not Be offended if you are an Pole Dance Instructor at another Pole or Exotic Dance or Fitness Studio and you are Not
permitted to drop in on our Classes. Prior permission from Robin will be necessary before you are allowed to join in or attend any of our
Drop In Classes. Instructors from Any Pole or Exotic Dance Studio that is not Affiliated with Dirty South Poles, Inc are under no
circumstances allowed to attend any of Pole Waxers University Pole & Exotic Dance Studio's Pole or Exotic Dance Series Classes.
I have read and understand the above confidentiality and non-disclosure policies. ____ (initial)
Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement
In consideration for your acceptance into the classes or Party Group provided by Dirty South Poles, Inc and other good and valuable
consideration paid, the receipt of which is hereby acknowledged, you hereby covenant and agree as Follows:
A.
I acknowledge that the activities undertaken in the class sessions, private classes, parties or any Other activity provided or facilitated by
Dirty South Poles, Inc a/k/a Pole Waxers University are hazardous and I recognize that my participation in the activities is strictly voluntary. I
assume all responsibility and risk associated with any and all activity, program, course, or class that I participate in, and assume all
responsibility and liability of physical fitness and capability to perform any and all activity or effort related to and/or associated with the class
activities performed by me or which I am involved in.
The risks that I am agreeing to assume include the risk that an injury may be caused by physical conditions at the class location or by the
negligence of Dirty South Poles, Inc, its agents, employees, representatives, by me, or by other students or Party guest. I represent that, to
the best of my knowledge, I have no medical, physical, mental or emotional health condition which would affect, hinder or prevent my active
participation in any class sessions, private classes, parties or other activities provided or
Facilitated by Dirty South Poles, Inc a/k/a Pole Waxers University. Furthermore, I understand that Pole Waxers Beginners Level Pole Dance
Classes are structured towards the Adult Entertainment Dance Professional & acknowledge that Dirty South Poles Inc, allows Only Students
who are Currently Legally Permitted through City of Atlanta/Fulton County, Unincorporated Fulton County, or such counties required for
Entertainer to be licenced/permitted strictly as a Adult Entertainers to duplicate Pole Dance techniques, routines & allows students to
incorporate above mentioned into her Stage Set or Floor Stage performance.
B.
I, including my heirs and assigns, to the maximum extent allowed by law, agree to release, give up and forever discharge Dirty South Poles,
Inc a/k/a Pole Waxers University (as defined in footnote one, above) and all of their agents, employees, managers, representatives, officers,
directors, attorneys, partners, insurers, heirs, predecessors in interest, advisors, successors and assigns, including www.Hardcorepoles.
com, www.stinkiepinkie.com, www.polewaxersuniversity.com, from any and all acts of negligence and all other claims and/or demands
whatsoever which I, any third party, or any persons acting on my or
Their behalf have or may have against any of the Releases by reason of any accident, illness, injury to or death of any person or persons,
or damage to or loss or destruction of any property arising or resulting directly or indirectly from participation in the class sessions, private
classes, parties or other activities (including but not limited to any injury or damage occurring while I am on Dirty South Poles, Inc Premises
or while using/renting of Products such as Dance Poles, or Stage Pole Combos,
Dirty South Poles, Inc facilities or equipment in any way) provided or facilitated by Dirty South Poles, whether such injury or damage occurs
during the participation or at any time subsequent to the participation.
C.
I further agree that, to the maximum extent allowed by law, I shall indemnify, release, and hold harmless the Releases from any and all
claims, losses, illnesses, demands, and injuries to my person or property, foreseen or unforeseen, resulting from, caused by, or related in
any way to my participation in and/or presence at any class, program, party or activity (including but not limited to any injury or damage
occurring while I am on Dirty South Poles, Inc premises or while using Dirty South Poles, Inc facilities or equipment in any way) provided or
facilitated by Dirty South Poles,Inc, including acts of negligence on the part of myself, any of the Releases or any third party).
I agree to indemnify the Releases, and any of them, to the maximum extent allowed by law, for any cost, expense (including reasonable
attorneys’ fees and costs), and loss caused in any way by me. This Hold Harmless Agreement is not in derogation of, but rather
supplements, any common law rights to
Indemnification to which Dirty South Poles, Inc, its legal representatives, successors, and assigns may have. I acknowledge that this Hold
Harmless Agreement is binding on and on my successors and assigns.
D.
I hereby acknowledge and affirm that I have read the contents of this Agreement, I understand its terms, and I knowingly and voluntarily
execute this agreement under my own free will, without relying on any statement or representation of Dirty South Poles, Inc or any of the
Releases. I understand this Section 3: Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement is a
release of legal liability, an assumption of risk of hazardous activity and an agreement to indemnify for the acts of myself and others. I
expressly agree that this
Section 3: Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement is intended to be as broad and
inclusive as is permitted by law and that if any portion of this Section 3 is held invalid, it is agreed that the balance shall, notwithstanding,
continue in full Legal force & effect.
I have read and understand the above Release of All Claims (Including Negligence), Hold Harmless and Indemnification
Agreement provisions. _____(Initial)
I Confirm that I am over the age of 18 Years Old._____(Initial)
I Confirm that I am not Currently Pregnant.______(Initial)
I Do NOT work as an Adult Entertainment Dancer________(initial)
I DO CURRENTLY work as an Adult Entertainment Dancer & I am employed at ___________________ ______(initial)
Section 4:
Arbitration of Disputes
I acknowledge and agree that the terms outlined herein are contractual. Any and all disputes or claims arising out of or in any way related to
this Agreement, including without limitation, fraud in the inducement of this
Agreement, or relating to the general validity or enforceability of this Agreement, as well as any claims arising out of my participation in any
activity, program, course or class provided by Dirty South Poles, Inc shall be submitted
To final and binding arbitration before an arbitrator in Cobb County, Georgia in accordance with the rules of that arbitration service provider
governing commercial disputes. The cost of the arbitration shall be
Split equally by all parties to the arbitration. The prevailing party shall be entitled to reasonable costs and attorneys’ fees. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction thereof.
Section 5:
Sever ability, Amendment, Third-Party Beneficiaries, Governing Law, Assignment
If any provision of this Agreement is held to be unenforceable, each such unenforceable provision shall be excluded from this Agreement,
and the balance of the agreement shall be interpreted as if each such unenforceable provision were excluded; provided, however, that if a
provision is held unenforceable because it is excessively broad or unreasonable as to scope or subject, such provision shall continue to be
enforced to the extent necessary to be reasonable under the circumstances and consistent with applicable law while reflecting as
Closely as possible the intent of the parties as expressed herein.
Section 6:
Writing signed by an authorized representative of Dirty South Poles, Inc. The parties hereto intend that this Agreement shall not benefit or
create any right or cause of action in or on behalf of any person other than the
Parties hereto, except that the parties agree that Dirty South Poles, Inc and/or www.hardcorepoles.com, www.stinkiepinkie.com, www.
polewaxersuniversity.com shall be Entitled to enforce the terms of this Agreement. This Agreement shall be governed by and interpreted in
Accordance with the laws of the Georgia. This Agreement and all rights under this Agreement shall be
Binding upon and inure to the benefit of and be enforceable by the parties hereto and their respective personal or\ legal representatives,
executors, administrators, heirs, distributes, devises, legatees, successors and assigns. The relevant Pole Waxers University entity with
whom you have contracted (see footnote 2, above) may assign any or all of its rights and obligations under this Agreement to any of its
related, parent, affiliated or subsidiary entities.
Section 7:
Students Privacy:
We Dirty South Poles, Inc. Promise not to sell, or share students personal information, email addresses, or phone numbers. Students
understand that Dirty South Poles, Inc often will film or record class sessions and post clips of class progress on our website, youtube,
myspace, or other advertising methods, in return Dirty South Poles, Inc will continue offering the low introductory 4 week class price to
compensate student. Student understands that all pictures and Video recordings, clips, or advertising trailers are the property of Dirty
South Poles, Inc. Dirty South Poles, Inc agrees not to list students names or any personal information, in such advertising methods.
Students understand and agree to allow pictures to be used, & in the event that student does not wish for her picture to be shown she will
inform us below as noted.
I do not mind video clips of me in class to be shown, as long as my name and Personal information is not shown and editing is done in a
tasteful manor.__________________
I do not wish for any class pictures, or videos of me to be used in any advertisements___________
Student/Guest name ___________________________________
(Please print)
Student/Guest signature_________________________________
Date ___________________________________________
Class___________________Enrollment Date__________________
Level__________________________
POLE WAXERS STUDENT AGREEMENT:
Welcome to POLE WAXERS UNIVERSITY, A/K/A DIRTY SOUTH POLES, INC, WWW.HARDCOREPOLES.COM, WWW.STINKIEPINKIE.COM,
WWW.POLEWAXERSUNIVERSITY.COM (1) This Student Agreement (“Agreement”) is being entered into by you Dirty South Poles, Inc
( 2)
When you sign up for a Pole Waxers Pole Dance class, we are committing to provide you a specific time slot in a specific class with a Pole
Waxers instructor subject to the terms and conditions contained in this Agreement, thereby making this
Time slot unavailable to others. Please understand the commitment we are making to you does force us to adhere to a set of policies and
prior to being admitted to any class or other Pole Waxers activity, you must agree to the terms of this Agreement.
These policies and the other terms are outlined below and are subject to change from time to time.
Please read this Agreement carefully and ensure you understand the obligations you are undertaking before you sign this Agreement.
Section 1: Policies for class sessions, private classes, and parties
SECURING A CLASS:
To secure a time slot in a specific class, Payments must be made at any time online at www.polewaxersuniversity.com or prior to the First
Day of Class.
If full class payment is rejected through the Goggles Secure Checkout System we reserve the right to remove you from the class roster and
allow another student take your spot and your spot will be forfeited.
All references in this Agreement to “Dirty South Poles, Inc”
Or the “www.hardcorepoles.com, www.polewaxersuniversity.com or www.stinkiepinkie.com” shall mean
Pole Waxers or Pole Waxers University as well as all affiliated, related, parent and subsidiary entities.
REFUND POLICIES
Class Sessions
No refunds for class sessions will be made for any Pole Classes that have been discounted or that offer a Special Rate offer or for any of 4-
week Pole classes or Luscious Laps & Exotic Dance Class. Any other Pole Class Refunds will only be granted when requested a minimum of
15 days prior to the start of the class for which you are registered and notifying the studio where you are enrolled via email or in writing must
make ALL refund requests. Unless the
Minimum 15 day notice is given, you will not be eligible for a refund.
Medical Exception
Should you become injured or ill to the extent that participation in class is not advisable by your physician?
You may apply for a Medical Rollover of your unused classes toward a future session to be used within six months time provided your class
has been paid in full. In such cases, you must provide Pole Waxers with a written note from your physician describing your injury or illness,
relevant dates of injury or
Illness and treatment and you must sign out of class no later than 72 hours after such class was scheduled.
Failure to notify Pole Waxers within 72 hours after missing class due to said injury or illness would cause forfeiture of the possibility for a
Medical Rollover of your unused classes. Any request for medical
Exception may be granted or denied at Pole Waxers University’s sole discretion. In order to return to class, a written release from your
physician stating your ability to resume classes will be required.
Private Classes
Full payment is required to book a private class and such payment is nonrefundable. In consideration of your
Instructor’s schedule and others who may want the same time slot, 72 hours advance notice is required to
Reschedule your private class or your ability to reschedule will be forfeited. Any and all rescheduling will be at The sole discretion of Pole
Waxes University and subject to class availability.
POLE & EXOTIC DANCE PARTY
A Down Payment is required to book a party and is to be made online through our website www.polewaxersuniversity.com using Googles
Secure Checkout System and such payment is nonrefundable. The remaining balance is due in full by form of Cash Only at time of Your
Party paid at the Studio. In consideration of your Instructor’s schedule and others who may want the same time slot, 7 days advance notice
is required to reschedule your party, or your ability to reschedule your party will be forfeited. Any and all rescheduling will be at the sole
discretion of Pole Waxers University and subject to class availability.
I have read and understand the above policies. I understand that once Payments have been paid to Pole Waxers University,
There will be no refunds for classes, privates or parties scheduled, other than as expressly provided above. I understand and agree that I
am soley responsible for all of my guest. I understand and agree that it is my responsibility not to allow any quest under the age of 21 to
drink alcoholic beaverages while attending my party at Pole Waxers University.com.
____ (Initial)
OTHER POLICIES
Class Make-up Policy
For the convenience of our students we do allow students to miss any of our beginners 4 week classes, we do allow One class per session
for 6 weeks classes and Two classes missed for 8 weeks and more classes, and if you have
Notified us of your absence in advance the missed classes can be made up. Make-up classes will only be scheduled If you have cancelled
your class (either by phone or online) at least 24 hours in advance. If you do not cancel out of your class your missed class will count as
used even though you did not attend and a make-up class will no
Longer be allowed. Due to scheduling constraints, Pole Waxers will contact you on availability for make up class session.
Missed classes do not rollover to future sessions unless you remain enrolled as a student of Pole Waxers University. If you 90 days. Once a
make-up class is scheduled, if not cancelled at least 24 hours in advance, it counts as used even if not attended.
I have read and understand the above make-up policy. ____ (initial)
Safety
In the interest of safety, any individual who appears intoxicated or otherwise disruptive to the conduct of a class, Private or party may, at the
sole discretion of Pole Waxers University, be asked not to participate in class,
Forfeiting any deposits and payments made by that person for that session, private or party.
Arrival and Departure Times
We ask that you are considerate of other students and arrive a few minutes prior to your sessions’ scheduled start time. You may depart at
any time once the session has started but you cannot make up the class time
Should you choose to depart early?
Confidentiality and Non-disclosure
By signing below, you acknowledge that all class content, including but not limited to teaching method, curriculum,
Discussions, written materials, movements, dance steps, routines, choreography and scenery (the “Proprietary Information”) are the
property of Dirty South Poles, Inc and constitute confidential and proprietary business Information and trade secrets, the unauthorized
disclosure of which will irreparably harm Dirty South Poles, Inc.a/k/a Pole Waxers University.
You further agree that in exchange for Dirty South Poles, Inc agreeing to take you on as a student or Party Group, you agree to keep the
Proprietary Information confidential and that you will not disclose the Proprietary Information to anyone
Without the prior written consent of Dirty South Poles, Inc. You further agree that you will not teach to any third party any of the Proprietary
Information, and that you will refer any person wishing to learn any of the Proprietary Information to Dirty South Poles, Inc a/k/a Pole Waxers
University. You further expressly agree that you will not use the Proprietary Information for the purpose of soliciting any students/ employees
/ or Instructors of Dirty South Poles, Inc or to Otherwise compete with Dirty South Poles, Inc a/k/a Pole Waxers University.
I confirm that I am not an employee or employed with any Pole Dance Studio, Private Pole Dance Instructor or Facility in which teaches
Pole Dance, Exotic Dance or similar._______(initial)
( Please Do Not Be offended if you are an Pole Dance Instructor at another Pole or Exotic Dance or Fitness Studio and you are Not
permitted to drop in on our Classes. Prior permission from Robin will be necessary before you are allowed to join in or attend any of our
Drop In Classes. Instructors from Any Pole or Exotic Dance Studio that is not Affiliated with Dirty South Poles, Inc are under no
circumstances allowed to attend any of Pole Waxers University Pole & Exotic Dance Studio's Pole or Exotic Dance Series Classes.
I have read and understand the above confidentiality and non-disclosure policies. ____ (initial)
Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement
In consideration for your acceptance into the classes or Party Group provided by Dirty South Poles, Inc and other good and valuable
consideration paid, the receipt of which is hereby acknowledged, you hereby covenant and agree as Follows:
A.
I acknowledge that the activities undertaken in the class sessions, private classes, parties or any Other activity provided or facilitated by
Dirty South Poles, Inc a/k/a Pole Waxers University are hazardous and I recognize that my participation in the activities is strictly voluntary. I
assume all responsibility and risk associated with any and all activity, program, course, or class that I participate in, and assume all
responsibility and liability of physical fitness and capability to perform any and all activity or effort related to and/or associated with the class
activities performed by me or which I am involved in.
The risks that I am agreeing to assume include the risk that an injury may be caused by physical conditions at the class location or by the
negligence of Dirty South Poles, Inc, its agents, employees, representatives, by me, or by other students or Party guest. I represent that, to
the best of my knowledge, I have no medical, physical, mental or emotional health condition which would affect, hinder or prevent my active
participation in any class sessions, private classes, parties or other activities provided or
Facilitated by Dirty South Poles, Inc a/k/a Pole Waxers University. Furthermore, I understand that Pole Waxers Beginners Level Pole Dance
Classes are structured towards the Adult Entertainment Dance Professional & acknowledge that Dirty South Poles Inc, allows Only Students
who are Currently Legally Permitted through City of Atlanta/Fulton County, Unincorporated Fulton County, or such counties required for
Entertainer to be licenced/permitted strictly as a Adult Entertainers to duplicate Pole Dance techniques, routines & allows students to
incorporate above mentioned into her Stage Set or Floor Stage performance.
B.
I, including my heirs and assigns, to the maximum extent allowed by law, agree to release, give up and forever discharge Dirty South Poles,
Inc a/k/a Pole Waxers University (as defined in footnote one, above) and all of their agents, employees, managers, representatives, officers,
directors, attorneys, partners, insurers, heirs, predecessors in interest, advisors, successors and assigns, including www.Hardcorepoles.
com, www.stinkiepinkie.com, www.polewaxersuniversity.com, from any and all acts of negligence and all other claims and/or demands
whatsoever which I, any third party, or any persons acting on my or
Their behalf have or may have against any of the Releases by reason of any accident, illness, injury to or death of any person or persons,
or damage to or loss or destruction of any property arising or resulting directly or indirectly from participation in the class sessions, private
classes, parties or other activities (including but not limited to any injury or damage occurring while I am on Dirty South Poles, Inc Premises
or while using/renting of Products such as Dance Poles, or Stage Pole Combos,
Dirty South Poles, Inc facilities or equipment in any way) provided or facilitated by Dirty South Poles, whether such injury or damage occurs
during the participation or at any time subsequent to the participation.
C.
I further agree that, to the maximum extent allowed by law, I shall indemnify, release, and hold harmless the Releases from any and all
claims, losses, illnesses, demands, and injuries to my person or property, foreseen or unforeseen, resulting from, caused by, or related in
any way to my participation in and/or presence at any class, program, party or activity (including but not limited to any injury or damage
occurring while I am on Dirty South Poles, Inc premises or while using Dirty South Poles, Inc facilities or equipment in any way) provided or
facilitated by Dirty South Poles,Inc, including acts of negligence on the part of myself, any of the Releases or any third party).
I agree to indemnify the Releases, and any of them, to the maximum extent allowed by law, for any cost, expense (including reasonable
attorneys’ fees and costs), and loss caused in any way by me. This Hold Harmless Agreement is not in derogation of, but rather
supplements, any common law rights to
Indemnification to which Dirty South Poles, Inc, its legal representatives, successors, and assigns may have. I acknowledge that this Hold
Harmless Agreement is binding on and on my successors and assigns.
D.
I hereby acknowledge and affirm that I have read the contents of this Agreement, I understand its terms, and I knowingly and voluntarily
execute this agreement under my own free will, without relying on any statement or representation of Dirty South Poles, Inc or any of the
Releases. I understand this Section 3: Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement is a
release of legal liability, an assumption of risk of hazardous activity and an agreement to indemnify for the acts of myself and others. I
expressly agree that this
Section 3: Release of All Claims (Including Negligence), Hold Harmless and Indemnification Agreement is intended to be as broad and
inclusive as is permitted by law and that if any portion of this Section 3 is held invalid, it is agreed that the balance shall, notwithstanding,
continue in full Legal force & effect.
I have read and understand the above Release of All Claims (Including Negligence), Hold Harmless and Indemnification
Agreement provisions. _____(Initial)
I Confirm that I am over the age of 18 Years Old._____(Initial)
I Confirm that I am not Currently Pregnant.______(Initial)
I Do NOT work as an Adult Entertainment Dancer________(initial)
I DO CURRENTLY work as an Adult Entertainment Dancer & I am employed at ___________________ ______(initial)
Section 4:
Arbitration of Disputes
I acknowledge and agree that the terms outlined herein are contractual. Any and all disputes or claims arising out of or in any way related to
this Agreement, including without limitation, fraud in the inducement of this
Agreement, or relating to the general validity or enforceability of this Agreement, as well as any claims arising out of my participation in any
activity, program, course or class provided by Dirty South Poles, Inc shall be submitted
To final and binding arbitration before an arbitrator in Cobb County, Georgia in accordance with the rules of that arbitration service provider
governing commercial disputes. The cost of the arbitration shall be
Split equally by all parties to the arbitration. The prevailing party shall be entitled to reasonable costs and attorneys’ fees. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction thereof.
Section 5:
Sever ability, Amendment, Third-Party Beneficiaries, Governing Law, Assignment
If any provision of this Agreement is held to be unenforceable, each such unenforceable provision shall be excluded from this Agreement,
and the balance of the agreement shall be interpreted as if each such unenforceable provision were excluded; provided, however, that if a
provision is held unenforceable because it is excessively broad or unreasonable as to scope or subject, such provision shall continue to be
enforced to the extent necessary to be reasonable under the circumstances and consistent with applicable law while reflecting as
Closely as possible the intent of the parties as expressed herein.
Section 6:
Writing signed by an authorized representative of Dirty South Poles, Inc. The parties hereto intend that this Agreement shall not benefit or
create any right or cause of action in or on behalf of any person other than the
Parties hereto, except that the parties agree that Dirty South Poles, Inc and/or www.hardcorepoles.com, www.stinkiepinkie.com, www.
polewaxersuniversity.com shall be Entitled to enforce the terms of this Agreement. This Agreement shall be governed by and interpreted in
Accordance with the laws of the Georgia. This Agreement and all rights under this Agreement shall be
Binding upon and inure to the benefit of and be enforceable by the parties hereto and their respective personal or\ legal representatives,
executors, administrators, heirs, distributes, devises, legatees, successors and assigns. The relevant Pole Waxers University entity with
whom you have contracted (see footnote 2, above) may assign any or all of its rights and obligations under this Agreement to any of its
related, parent, affiliated or subsidiary entities.
Section 7:
Students Privacy:
We Dirty South Poles, Inc. Promise not to sell, or share students personal information, email addresses, or phone numbers. Students
understand that Dirty South Poles, Inc often will film or record class sessions and post clips of class progress on our website, youtube,
myspace, or other advertising methods, in return Dirty South Poles, Inc will continue offering the low introductory 4 week class price to
compensate student. Student understands that all pictures and Video recordings, clips, or advertising trailers are the property of Dirty
South Poles, Inc. Dirty South Poles, Inc agrees not to list students names or any personal information, in such advertising methods.
Students understand and agree to allow pictures to be used, & in the event that student does not wish for her picture to be shown she will
inform us below as noted.
I do not mind video clips of me in class to be shown, as long as my name and Personal information is not shown and editing is done in a
tasteful manor.__________________
I do not wish for any class pictures, or videos of me to be used in any advertisements___________
Student/Guest name ___________________________________
(Please print)
Student/Guest signature_________________________________
Date ___________________________________________