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Adult Athlete - Code of Conduct
Parent/Youth Athlete - Code of Conduct
NTC Release, Waiver, & Agreement
Dreamplex Para Sports Track & Field - Registration
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*
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Please print and sign the Code of Conduct. You can upload it here OR bring it to your first practice.
Max. file size: 50 MB.
Please print and sign the NTC Release, Waiver, & Agreement. You can upload it here OR bring it to your first practice.
Max. file size: 50 MB.
Participant Information
Please enter the following information about the person participating in the program.
Name
*
First
Last
Age
*
Date of Birth
*
Month
Day
Year
Disabilities
*
What is the primary disability associated with the participant? (if applicable)
Cerebral Palsy
Developmental Disability
Down Syndrome
Hearing Loss
Muscular Dystrophy
Spina Bifida
Spinal Cord Injury
Traumatic Brain Injury
Vision Loss
Other
Disabilities & Other Information (optional)
(Optional) Please feel free to expand on the participant's disabilities, or any other information about the participant, here. Include anything you would like the instructors/coaches to know.
Does the participant have their own equipment they'd like to use?
Yes
No
Participant Contact Information
Please enter the contact information for yourself, the parent, or caregiver
Name
*
First
Last
Relation to Participant
*
(e.g. Self, Parent, Caregiver)
Phone
*
Email
*
Address
*
Street Address
Address Line 2
City
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Vermont
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Armed Forces Americas
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State
ZIP Code
Emergency Contact Information
Please enter the contact information in case of emergency. (someone who will NOT be in attendance at the event and NOT the same person listed above)
Relation to Participant
*
Name
*
This person will be contacted, only in the case of emergency
First
Last
Phone
*
Emergency Email
*
Consent
*
WAIVER:
I, parent or guardian of the above named participant, understand that participation in this recreational program involves the risk of injury. I further understand that before my child participates in this program, I should consult his/her physician. By signing this form, I acknowledge all risks of injury and death and affirm I am willing to assume responsibility should injury or death result from them. I also agree to follow all rules and procedures of the program and to instruct my child to follow reasonable instructions of the coaches, volunteers, and supervisors of the program. Furthermore, in return for the opportunity to participate in this program, I agree for myself, and for my heirs, assigns, executors, and administrators, to waive any legal rights I may have to seek payment of any kind from the Central Florida Dreamplex, its employees, or its agents for bodily injury or death resulting from this program and to release those parties from any liability for damages resulting from my child’s injuries or death. I understand that no insurance is provided by the Central Florida Dreamplex. In case of emergency that requires immediate action and I (we) cannot be contacted, or time is of the essence, I (we) give permission for the program supervisors to make decisions and act on my behalf concerning the welfare of my child.
RELEASE OF LIABILITY AGREEMENT IN RELATION TO COMMUNICABLE DISEASES
The undersigned recognizes and understands that while Released Parties have undertaken reasonable steps to lessen the risk of transmission of communicable diseases, including but not limited to, COVID-19, in connection with participation in the activities, the Released Parties are not responsible in any manner for any risks related to communicable diseases in connection with Participant's participation in the activities. Specifically, the undersigned understands that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in significant personal injury or death. The Undersigned is fully aware that participation in the activities carries with it certain inherent risks related to transmission of communicable diseases ("Inherent Risks") that cannot be eliminated regardless of the care taken to avoid such risks.
Inherent risks may include, but are not limited to, 1)the risk of coming into close contact with individuals or objects that may be carrying a communicable disease, 2)the risk of transmitting or contracting a communicable disease, directly or indirectly, to or from other individuals; and 3)injuries and complications ranging in severity from minor to catastrophic, including death, resulting directly or indirectly from communicable diseases or the treatment thereof.
Further, the undersigned understands that the risk of all communicable diseases are not fully understood, and that contact with, or transmission of, a communicable disease may result in risks to the Participant including but not limited to loss, personal injury, sickness, death, damage, and expense, the exact nature of which are not currently ascertainable, and all of which are to be considered inherent risks. The undersigned hereby voluntarily accepts and assumes all risk of loss, personal injury, sickness, death, damage, and expense for the Participant arising from such inherent risks. Furthermore, the undersigned represents and warrants that participant does not knowingly carry any communicable diseases that may be transmitted during participation in the activities.
MEDIA RELEASE:
I hereby give my full consent to allow my child’s photo, video, and likeness to be used for any and all purposes deemed appropriate by Central Florida Dreamplex, which may include, but not be limited to, use in any exhibitions, public displays, publications, commercials, art, and advertising, and shall not seek compensation for any use thereof by Central Florida Dreamplex.
I agree to the Warning, Liability, Release, and Acknowledgment & Assumption of Risks
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