Request edit access
Polar Star Waiver and Release of Liability 
Sign in to Google to save your progress. Learn more
Email *
In consideration of being allowed to participate in any way in Polar Star related events and activities, the undersigned: 

1. Agree to be bound by all the terms set forth herein, in this Polar Star Waiver and Release of Liability.

2. Understand that Polar Star will make all efforts to keep our students safe on site at the school and on all field trips, parties, gatherings, excursions, or while carpooling to and from school events and classes for the school year. If the parent or guardian believes anything is unsafe, he or she should immediately advise the current Board or mentors of such condition(s) and refuse to participate.

3. Understand that students should be aware of their physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. 

4. Exempt, release, and indemnify Polar Star, its Board members, staff, volunteers, students, and parents from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my spouse, my children, or property which may arise out of or in connection with participation in any classes or activities provided by Polar Star. 

5. Release, waive, discharge and covenant not to sue Polar Star.  I voluntarily agree to assume all risks and responsibility for the damages following such injury, permanent disability or death which might occur to myself, my spouse or my student.

6. Further hereby voluntarily agree that Polar Star shall have the right to use photos for the Polar Star yearbook or website. 

I HAVE READ THE ABOVE WAIVER AND RELEASE. My electronic signature is proof of my intention to execute a complete and unconditional waiver of all liability, on behalf of any individual in my family to the fullest extent of the law. 

Please list all family members that will be participating in Polar Star or its activities this year.

Address of Family Members Participating *
Name of Parent/Legal Guardian  *
Name of Parent/Legal Guardian
Name of Student *
Additional Student
Additional Student
Additional Student
Additional Student
Additional Student
Additional Student
Additional Student
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report