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Member Information
Participant Name
(Required)
First
Last
Participate Birth Date
MM slash DD slash YYYY
Parent Name
(Required)
First
Last
Parent Email
(Required)
Parent Phone
(Required)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
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Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
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Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
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Faroe Islands
Fiji
Finland
France
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French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
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Greenland
Grenada
Guadeloupe
Guam
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Guinea-Bissau
Guyana
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Hungary
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India
Indonesia
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Iraq
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Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
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Paraguay
Peru
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Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
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Spain
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Sudan
Suriname
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Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Türkiye
US Minor Outlying Islands
Uganda
Ukraine
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Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Code of Conduct Agreement
(Required)
The Central Florida Dreamplex Code of Conduct is designed to ensure a positive, respectful, and safe experience for all participants, families, staff, instructors, and volunteers.
By agreeing to this Code of Conduct, I understand and agree that I will:
Act in the best interest of all participants and promote respect and inclusion
Treat all instructors, staff, volunteers, participants, and families with respect
Be punctual and dependable for classes and events
Encourage positive sportsmanship and appropriate behavior
Communicate calmly and respectfully, avoiding inappropriate language or behavior
Follow facility rules, registration requirements, and arrival procedures
I understand that failure to follow this Code of Conduct may result in corrective action, including removal from activities or programs.
By agreeing and signing my name below, I confirm that I have read, understand, and agree to follow this Code of Conduct.
I agree to the Code of Conduct Agreement.
Waiver & Release of Liability – Parent/Guardian Consent
(Required)
I hereby certify that I am the parent or legal guardian of the child named on this form and that my child is physically capable of participating in activities offered by Central Florida Dreamplex, unless otherwise stated in writing.
In consideration of my child’s participation, I voluntarily assume all risks associated with these activities, including the risk of serious injury, permanent disability, or death. I hereby waive, release, and discharge Central Florida Dreamplex, its staff, agents, affiliates, and volunteers from any and all liability, including claims arising from negligence.
I agree to indemnify and hold harmless Central Florida Dreamplex from any claims or damages resulting from my child’s participation. I understand that no amendment or modification of this agreement is valid unless made in writing by an authorized representative of Central Florida Dreamplex.
By agreeing and signing my name below, I acknowledge that I have read and fully understand this waiver, that I am giving up certain legal rights, and that I agree to this waiver voluntarily.
I agree to the Waiver & Release of Liability.
Media & Photo Release
(Required)
I understand that during activities offered by Central Florida Dreamplex, my child may be photographed and/or recorded. I give my consent for my child’s photo, video, and likeness to be used by Central Florida Dreamplex for purposes including, but not limited to, exhibitions, public displays, publications, marketing, advertising, and promotional materials. I understand that no compensation will be provided for the use of these images.
Yes, I grant permission
No, I do not grant permission
Signature
(Required)
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