Contact Information

The above named participant agrees to indemnify and hold harmless Polaris Contemporary Dance Center (hereinafter referred to as PCDC), its Employees, Agents, Officers, Board Members, Volunteers or any other person against loss or expense, including attorney fees, due to any bodily injury, personal injury or property damage which may result from any and all activities while participating in classes or any other activity sponsored by or conducted by PCDC, or while visiting any facilities owned by, leased by, or controlled by PCDC. 

Image Waiver

Image Waiver: Guardians or students above the age of 18 give their permission to PCDC to use photos and/or video of their child without remuneration in connection with school publications, advertising, tv and news coverage.

First Aid or Emergency Measures

I grant permission to the staff of PCDC to take first aid or emergency measures as judged necessary. In case of a medical emergency, I understand that the student will be transported to an appropriate medical facility, if necessary. By completing this form and submitting to PDT, you agree to these conditions. 

Emergency Contact Info

In the event of injury to participant/child and the parent or legal guardian cannot be contacted, please provide the name and telephone number(s) of the relative or friend who should be contacted:

Medical Information

How did you hear about us?

Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

Polaris Dance Theatre cannot prevent your student from becoming exposed to, contracting, or spreading COVID-19 while utilizing Polaris Program services or premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize Polaris Dance Theatre’s services and/or enter the Polaris Dance Theatre premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my student in order to utilize Polaris Dance Theatre’s services and/or enter premises. These services are of such value to me and/or my student that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Polaris Dance Theatre’s services and premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Polaris Dance Theatre, Polaris Dance Theatre Staff, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Polaris Dance Theatre’s programming and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of Oregon will apply to this contract.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

I am the student or the parent/legal guardian of the minor named above. I have the legal right to consent to and, by accepting below, I hereby do consent to the terms and conditions of this Release.

I hereby do consent to the Terms and Conditions of this Release.