Dojo Summer Camp 2025

Polaris Dojo Summer Camps 2025
Parent/ Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
May we text or call you at this number?*

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to Participant*
(i.e. mother, father, uncle, friend, etc)

Student Name*

First NameLast Name
Birthday*

MonthDayYear
Would you like to add an additional student?*

YesNo
Student Name

First NameLast Name
Birthday

MonthDayYear
Student Name

First NameLast Name
Birthday

MonthDayYear
Student Name

First NameLast Name
Birthday

MonthDayYear
Student Name

First NameLast Name
Birthday

MonthDayYear
Student Name

First NameLast Name
Birthday

MonthDayYear
Student Name

First NameLast Name
Birthday

MonthDayYear

Liability Waiver
“I have enrolled in the personalized health and fitness program offered through Polaris Dojo. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary and in no way mandated by Polaris Dojo.

“In consideration of my participation in this program, I hereby release Polaris Dojo and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.” “I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Polaris Dojo and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death.”

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.
I agreeI do not agree

COVID-19 Liability Waiver
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Polaris Dojo has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Polaris Dojo can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.
I voluntarily seek services provided by Polaris Dojo and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Polaris Dojo harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Polaris Dojo. I understand that this release discharges Polaris Dojo from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Polaris Dojo. This liability waiver and release extends to the salon together with all owners, partners, and employees.
I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS*

I agreeI do not agree

Do you have any medical conditions that may affect your participation?

Media Release
I hereby agree and consent as follows.

A. I consent and authorize Polaris Dojo, located at PO Box 2889 Homer, AK 99603, to use my likeness in any photograph, video or other digital media (“Photos”) in any and all of its publications, including print or web-based publications.

B. I irrevocably authorize Polaris Dojo to copy, edit, enhance, crop, or otherwise alter any Photo for use in their publications. I also waive any rights for approval or inspection of any Photos.

C. I understand and agree that all Photos are the property of Polaris Dojo, and will not be returned to me.

D. I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos.

E. I agree to release and forever discharge Polaris Dojo and its affiliates, successors and assigns, officers, employees, representatives, partners, agents and anyone claiming through them, in their individual and/or corporate capacities from any and all claims, liabilities, obligations, promises, agreements, disputes, demands, damages, causes of action of any nature or kind, known or unknown, which I, and anyone claiming on behalf of me, may have or claim to have against Releasee in connection with this Release.

F. I have carefully read and fully understand all the provisions of this Photo Release Form and am freely, knowingly and voluntarily signing.
I agreeI do not agree

Please sign your acknowledgement.*

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Please Select which Program you are signing up for*

Rank up Camp: Session 1 (July 7-11)Rank up Camp: Session 2 (August 4-8)Camp Cosplay (July 14-18)
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Polaris Dojo Summer Camps 2025

Liability Waiver

COVID-19 Liability Waiver

Media Release