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Health & Safety Registration and Disclaimer Form

Event Date

Please enter the date of the event you will be attending. This will help us retrieve your disclaimer on the day.

Personal details

Emergency Contact Information

Emergency Contact # 1
Emergency Contact # 2

Medical Information


I give permission for myself to receive medical treatment in the event of an accident


I recognise that I may be asked to participate in some strenuous exercise during the course and that such participation may present a heightened risk of injury or ill health. All risks will be fully explained and I do NOT hold The Watermelon Studio and any of their staff responsible for any harm that may come to me should I decide to participate in such tasks. I knowingly assume all risks associated with participation, even if arising from negligence of the participants or others and assume full responsibility for my participation. I certify that I am in good physical condition can participate in the courses offered by The Watermelon Studio. I will not participate if pregnant or if I have given birth within the previous 6 weeks or C-section within the previous 12 weeks and I will update my teacher on any new medical condition/injury throughout my time at The Watermelon Studio. I will not participate under the influence of drugs or alcohol. Other teachers/instructors may use the information submitted in this form to help keep the chances of any injury to a minimum. I also hereby agree to follow all rules set out by The Watermelon Studio. I understand that photographs taken at the studio may be used on the studio's website and social media pages. I have read and agree to the terms and conditions on the website.

Online classes:

I accept that I am responsible for providing all of my own equipment including but not limited to the pole (which must be purchased from a professional manufacturer and installed as per the manufacturer guidelines), safety mat, clothing and footwear and the instructor will not accept any liability arising out of defective equipment. I acknowledge that the instructor is not present with me and cannot make an adequate assessment of the area where I am exercising and it is my responsibility to ensure the area is clear, safe and free from any hazards which may cause injury to me or to others.

I acknowledge that I am responsible for exercising within my own skill and fitness levels. If at any time I feel the moves I am completing are above my current skill level I will cease immediately. Likewise if I feel any discomfort, pain, sickness or dizziness I will immediately stop the activity.

I confirm that I am aged 18 or over

If you have any additional questions or concerns, please contact