• Heart condition or chest pain?
  • High or low blood pressure?
  • Faintness or dizzy spells?
  • Asthma?
  • Diabetes?
  • Are you pregnant or post natal?
  • Have you had any operation the last year?
  • Have you any recent injuries?
  • Any bone or joint problems?
  • Are you on any prescribed medicines or dietary supplements?
  • Have you any other medical condition not previously mentioned?

If you answer yes to any of the above questions, please detail below. We would recommend that you seek advice and confirmation from your doctor prior to participating in the class.


Do you participate regularly in any activity or exercise? What are your goals and aims of exercise? Please give details below:


The aim of the session is to improve cardiovascular fitness, muscular strength and endurance,  
flexibility and to learn new pole fitness moves. The sessions will begin with a warm up and then a 
recap of moves learnt from the previous week. We will then learn a series or new moves or transitions, finishing with a cool down incorporating stretches to improve flexibility. Please notify
the instructor before the session if you have sustained any injuries, illnesses, or medical conditions
or if you feel that there are parts of the session you are unable to take part in, participation is 
completely voluntary. All information given to the instructor is completely private and confidential 
under data legislation. Please ask as many questions as you need during the session, especially if you do not completely understand any move demonstrated. As with all exercise, pole fitness classes carry an element of risk and you may experience some bruising or burn and feel slightly achy for a few days afterwards. This session has been designed to minimise the risks and with continued practise your body will become conditioned to the movements involved. If during the session you feel excessive pain or discomfort, please notify the instructor immediately. Sign below to confirm that you have agreed to participate in the session described above and that you understand you are able to withdraw from the session at any time.

Booking is made through the website or via bank transfer, bank transfer is preferred as it saves on fees. From the home page, select the session you are interested which will take you to a payment page. Booking is not confirmed and your place unsecured until payment is made. Please see our cancellation policy for further details.

Bank transfer can be made to: Samantha Walsh, Barclays Bank, account 63075265, sort 20-15-70

Thank you for your custom.

As part of the lesson you will be required to do a warm up and cool down, these are vital parts of the session and cannot be skipped so yo must arrive on time. For your own safety, you may be asked to leave the session if the warm up has not been completed. Do not apply moisturiser or fake tan on the day of your class, this will make you slippy and is dangerous! It will also compromise the safety of the equipment for other users. We will never expect you go upside down (invert) in your first sessions. Please seek spotting assistance from your instructor and guidance for anything you are not sure of.

Do not attempt moves that have not been taught by your instructor, this includes moves learnt at other studios or demonstrated by other students. This will invalidate our insurance and is dangerous to yourself and others. We ensure that you are taught safely and within your own ability, we can not accept responsibility for moves that are taught incorrectly or without the correct technique and we are not responsible for any injury caused by attempting these moves.

Under no circumstance will we accept any student under the influence of drink or drugs. You will be asked to leave.

We ask you to remove all jewellery so as to avoid injury to yourself, damage to your jewellery and damage to the equipment. We cannot accept responsibility for any jewellery left onsite or mislaid during sessions. We suggest leaving items of sentiment or value at home or disposing of them carefully in your personal possessions before commencing a class.

Abusive or disrespectful behaviour will not be tolerated and you will be asked to leave with no option to recoup lost monies. Please treat your instructor and fellow students how you would expect to be treated, following rules at all times.

You are welcome to bring your own mats to stretch and warm up on, we will provide them if needed along with straps and yoga blocks.

You can also use whatever grip assistance you need provided you clean the equipment after use and make it ready for the next student to safely utilise it.

Lastly, enjoy, grow, nurture, excel. We are a proud, caring inclusive community wishing the best for all our fellow pole sisters and brothers. If you need to speak to us in confidence then do it. If you have suggestions, ideas, criticisms let us have them. Our business model is designed to work around you, no obligations, no bulk costs to pay, flexible and accommodating at all times. We promote full transparency in all our dealings and appreciate that people will visit other studios, do other workshops, take other privates, and all we ask is that you invite us!

Much love, peace out ❣

Unfortunately we cannot give refunds. If you cannot attend a booked Private session we will endeavour to fill that session for you if 48 hours notice is given. For studio sessions you can make up that session in one of the other classes we offer, subject to availability. Payment is required to secure any booking, we cannot offer refunds for privates or studio sessions at any time and sessions cannot be carried over.

We do not offer memberships, our private and studio sessions are designed to give you the freedom to book whenever you want and whenever circumstances allow. Regular students are given the option to attend Privates at the home studio for a substantially reduced rate wherever availability allows. Booking is not confirmed until payment in full is received.

You can buy a block booking of private lessons, ask me for discount! There is no expiration date on these, giving you the freedom to schedule around your commitments.

These are our policies concerning the collection, use and disclosure of personal information when you use our services. We will not use or share your information with anyone except as described in this Privacy Policy.

We may use your personal information for facilitating and improving the services we offer to you. By using our services you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this policy, the terms used have the same meanings as our Terms and Conditions.

We may ask you to provide us with certain personal details to enable us to identify you or when needed, to contact you, this may include name, email address, telephone number and address.

When browsing the internet we may collect the information that your browser sends whenever you visit us. This data may include your computer’s IP address, browser type and version, the pages that you visit, the time and date of your visit, the time spent on those pages and other statistics.

We use “cookies” to collect your information. These are small data files which may include an anonymous unique identifier. Cookies are sent to your browser from a web site and stored on your computer’s hard drive. You can instruct your browser to refuse these or to indicate when a cookie is being sent, however, if you do not accept cookies, it will limit some of the services we offer to you.

The privacy of your personal information is of utmost importance to us but we cannot guarantee that any electronic method of transmission or storage is perfectly secure. Whilst we endeavour to use any means necessary to protect your personal information we cannot absolutely guarantee its security.

This website may contain third party links to other sites that are not operated by us. Please review the privacy policy of every website you visit, specifically pertaining to any you may find whilst using our service. We have no control over, and assume no responsibility for the content, privacy policies or practices of any third party sites or services.

We do not knowingly collect personal information from children under the age of 18. As a parent you are responsible for providing any information we ask for, we cannot accept information that has been given to us by anyone under 18 years of age and we will delete that information straight away.

If required, we have the right to disclose your personal information for legal purposes or by subpoena.

We have the right to change this Privacy Policy at any time. We will notify you of any changes by email and updating the new Privacy Policy on this page and you are advised to review this page regularly for any changes. Please contact us for any questions you may have on this Privacy Policy.

These are our policies concerning the collection, use and disclosure of personal information when you use our services. We will not use or share your information with anyone except as described in this Privacy Policy.

We may use your personal information for facilitating and improving the services we offer to you. By using our services you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this policy, the terms used have the same meanings as our Terms and Conditions.

Please find below Samantha Walsh Pole Dance and Fitness’s safety statement with regards to Covid-19. Please sign to say that each time you attend the studio, you agree to the following.

To the best of my knowledge, I:

 Have not shown any symptoms of Covid-19 in the past 14 days. According to the NHS and Gov.UK, below are the main symptoms: High temperature new, continuous cough, loss or change to your sense of smell or taste.
 Have not been in contact with anyone who has tested positive for Covid-19 or shown any of the above symptoms in the past 14 days.
 Have worn a protective mask when in public situations where social distancing is not consistently possible.
 Understand I could be a carrier of Covid-19 and be asymptomatic.
 Understand that I could contract Covid-19 from an asymptomatic person at our studio or from a contaminated surface at our studio.
 Am fully aware of the studio’s safety procedures (posted on our website) to prevent the spread of Covid-19 and will follow these procedures.
 Agree to inform the studio immediately if I have developed symptoms within a two week period of being in the studio, or if I have learned that I have been in direct contact with someone who has later tested positive for Covid-19 within the same two week period or travelled in the last 14 days to a Covid-19 risk area.
 Agree to inform the studio of any allergies that I may have to cleaning products, PPE or similar that may be used at this time and may adversely affect my health.
 Agree that my data provided on this form can be used to contact me if I have been in a class with a person that has developed symptoms or has been in direct contact with somebody who has later tested positive for Covid-19.
 Understand that if I willfully and intentionally violate the stated hygiene policy and social distancing policy in our studio, the studio has the right to immediately remove me from class and suspend me from attending any future classes, without a refund.
 Agree to inform the studio immediately if I learn that any of the above information changes or I obtain new information.

Please sign on behalf of your child if under 16 years of age.


If you develop symptoms within a two-week period of being at the studio, or if you learn that you have been in direct contact with somebody who has later tested positive, we would ask you to contact Samantha Walsh of Samantha Walsh Pole Dance and Fitness on 07958 649046 or sam@geek-it.co.uk as soon as possible. Your name and personal details will be kept confidential at all times, as per our data protection policy.


If somebody within your class has developed symptoms (or been in direct contact with somebody who has tested positive) and notified the studio, you will be advised as soon as possible to isolate for 14 days. We will be using the contact details on your Covid Informed Consent to contact you so please ensure they are up to date.


If we believe there have been cases of Covid-19 at the studio, then the studio will close for a period of 14 days to allow our team to conduct a rigorous deep clean of the premises. All students will be notified of a closure as soon as possible using the contact details stated on your Covid Informed Consent. Any classes cancelled due to a studio closure will be carried over to the next available session that we can offer.  


Any outbreaks will be recorded in full in the studio’s incident report book.


Once Stage 3 has been completed in full, the studio will reopen. All students will be notified by email confirming the reopening date and an up to date timetable.

At Samantha Walsh Pole Dance and Fitness we have implemented the below social distancing policy to stop the spread of Covid-19. We require all students, instructors and other visitors to the studio to abide by the below guidance at all times. Failure to do so may result in removal from the studio with any future attendance suspended without a refund.

  • Before your first class please familiarise yourself with the new studio rules below for social distancing conduct. We will operate an ‘outer circle’ ideology to keep students spaced apart during lessons and a ‘keep to the left’ rule for students sharing equipment and also for entering and exiting the building. The instructor will also go through this with you in class to ensure understanding.
  • Please remain in your vehicle until your instructor calls you into class – this will allow the previous class time to exit, and time for our team to clean the studio ready for you.
  • Any attendees to the studio are required to adhere to a minimum of 2 metres social distancing from anybody that they do not live with.
  • As you enter the studio, please make your way to a free piece of equipment and stand next to it.
  • Looking inward, you are required to stand back from the ‘inner circle’. This will ensure that in both large studios of 6 poles that there is a circle of students as far apart as possible. Both studios are large enough to accommodate this effectively so please stay within those boundaries.
  • If sharing a pole, after cleaning it for the next user, please traverse in a linear fashion toward them bearing to the left. Do not cross into their area whilst in use or into another student’s equipment areas at any point during your class.
  • When you are not on your equipment try to ensure you are 2 metres away from the person next to you (mouth to mouth).
  • Please only leave your equipment area to wash your hands, use the bin, go to the bathroom or if you need medical attention.
  • Please move around the studio following the one-way system and any signage to this effect.
  • There is no storage area available to you at this time – please only bring into the studio with you what you will need for class and nothing more.
  • Please ensure you have water with you as our communal water facilities will not be available at this time.
  • Please ensure you bring your own grip with you as grip will no longer be available at the studio and we will not be allowing students to share grip between them.
  • Wear a face covering when suitable in the studio (not during exercise classes).