Adaptive Equipment Loan Request Form

Equipment Request

Should the Central Florida Dreamplex require the equipment for a clinic or other event, the “renter” will need to attend the event and/or return the equipment to make it available for said event. We reserve the right to request the equipment back at any time.
Please include type of equipment, along with quantity and size
MM slash DD slash YYYY
MM slash DD slash YYYY

AGREEMENT FOR USE OF ADAPTIVE SPORTS EQUIPMENT AND RELEASE AND WAIVER OF LIABILITY

Central Florida Dreamplex owns adaptive sports equipment including handcycles, racing wheelchairs, sports wheelchairs, and Grit off road chairs. Central Florida Dreamplex wants to make this equipment available for your use for training and recreation. To ensure that the equipment is used properly, and to ensure that the participant behaves responsibly, this agreement defines participant’s obligations made in exchange for using our equipment.
Participant Name
Parent or Legal Guardian Name
Address
Experience

AGREEMENT - PLEASE READ CAREFULLY

By completing this form, the participant agrees to use the equipment safely. Participant agrees to keep the equipment clean and in excellent working condition. If participant breaks or damages any part of the equipment, the participant agrees to replace the part.
Release and Waiver of Liability(Required)
Participant Signature
All participants under the age of 18 years are required to have a parent or legal guardian read and also sign this Release: The parent and the participant have read, understand and agree to comply with this release. By signing, the parent or guardian agrees to each of the provisions.
Parent/Legal Guardian Signature
All participants under the age of 18 years are required to have a parent or legal guardian read and also sign this Release: The parent and the participant have read, understand and agree to comply with this release. By signing, the parent or guardian agrees to each of the provisions.

Call or Email

Phone: 352-394-0212
Fax: 352-241-6361

Clermont Location Hours of Operation:

Therapy/Administrative Offices:
Monday-Thursday: 8:00 am – 4:00 pm
Friday: 8:00 am – 2:00 pm

Fitness Center:
Monday-Friday 8:00 am – 4:00 pm
Open Tuesday and Thursday evenings for classes only
Saturday: Closed (available for Birthday Parties/Private Rentals)
Sunday: Closed (available for Birthday Parties/Private Rentals)

Name*

Stop By & Visit

Address:
2400 S Hwy 27 Suite B201
Clermont, FL 34711

Directions:
We are located on the 2nd floor of Hillside Terrace on South Highway 27 in Clermont.  Graffiti Junktion and Guru restaurants are in the same building. Driving on Highway 27, turn onto Brogden Dr. and make your first left into Hillside Terrace.  You can also turn at the light at Steves Rd. and Hwy 27 and follow the access road in front of the Harley Davidson dealership to reach our building complex.

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