FMCN Membership
Florida Math Circle There is no membership fee for people who attended the OMC session for FCTM. 
Email *
Your name (student name, if parent filling for student) *
Are you a student, teacher or none
 *
Email *
Current Grade studying/Teaching *
School attending (If homeschool, please specify) *
Is your school a title 1 school? *
County of school attending/teaching *
Ethnicity *
Home Address *
Parent Name(if filled for student), write NA otherwise *
Parent Phone Number (if filled for student), write NA otherwise *
Photo/Video Release
 *
This agreement applies to the Registrant(s)/Participant(s): In consideration of my wish to participate in an online event or program and related activities (collectively the “Event”) of the Orlando Math Circle, I agree:
(1) that the Orlando Math Circle (or its representatives) may take photographs or video of me during my participation in the Event (“Photographs” or “Video”);
(2) that I irrevocably grant the Orlando Math Circle (and its licensees and assigns) the worldwide right in perpetuity to use my name, and my likeness as depicted in the Photographs and/or Video in materials related to the Orlando Math Circle’s educational and charitable mission, including the right to reproduce, distribute, modify, and publicly display the Photographs and/or Video in any medium now known or later developed, including, promotion and fundraising for the Orlando Math Circle; and
(3) on behalf of myself, my heirs, family members, and executors, I irrevocably release the Orlando Math Circle from any claim of any nature, known or unknown, that I have or ever may have (including for invasion of privacy, libel, slander, portraying me in a false light, or breach of my right of publicity) based on use of the Photographs and/or Video or my name or likeness as described.
I understand that the Orlando Math Circle will rely on this release and that I may not revoke my permission or release. These terms are governed by the laws of the State of Florida applicable to releases.
In the case of a minor: I am a parent or legal guardian of the minor enrolled, and I agree that such minor and I are bound by all the terms of this release.
Liability Waiver *
As parent or legal guardian of the minor, (hereinafter "Child"), herby grant the permission necessary to allow Child to participate in Orlando Math Circle online or at any physical location where OMC events are held(the "Program"). I understand the Program does not guarantee the suitability of the Program for Child's participation. I understand that there are inherent risks involved in participating in the Program, and I realize that participation in the Program is my and the Child's choice. I am aware that, during the program, certain risks and dangers may occur, including, but not limited to accident or illness; the forces of nature; all manner of foreseen and unforeseen bodily and personal injuries, including death; damage to property; and the consequences resulting therefrom.
IN CONSIDERATION OF CHILD BEING PERMITTED TO ATTEND AND PARTICIPATE IN THE PROGRAM, I ACKNOWLEDGE AND VOLUNTARILY ASSUME ALL RISKS ASSOCIATED WITH THE PROGRAM.
I, on my own behalf, and on behalf of the Child, our heirs, representatives, executors, administrators and assign, for the sole consideration of Child being allowed to attend and participate in the program, do hereby release, relieve, covenant not to sue and forever discharge, defend, indemnify and hold harmless, Orlando Math Circle, its officers, agents, employees, students, and volunteers (hereinafter collectively "OMC") of any and from all claims, demands, rights, liabilities, losses, expenses and causes of action (with the exception of gross negligence or willful misconduct) of whatever kind or nature including, but not limited to, negligence, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, including death, resulting from any participation in or in any way connected with or arising out of the Program, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death)that the child may incur or sustain during the program, all activities associated with the program and while traveling to and from the site for the program whether or not the program actually occurs.
I, ON MY OWN BEHALF AND ON BEHALF OF THE CHILD, HEREBY WARRANT THAT I HAVE READ THIS RELEASE OF LIABILITY IN ITS ENTIRETY AND FULLY UNDERSTAND ITS COMMENTS. I, ON MY OWN BEHALF AND ON BEHALF OF THE CHILD, AM AWARE THAT THS RELEASE OF LIABILITY RELEASES OMC FROM LIABILITY AND CONTAIN AN ACKNOWLEDGMENT OF MY VOLUNTARY AND KNOWING ASSUMPTION OF THE RISK OF INJURY OR ILLNESS.
Online Event Policies *
Participants in online events or programs are expected to exhibit good behavior to ensure a positive experience for everyone. At its sole discretion, Orlando Math Circle may remove a participant from an online event or program for behavioral reasons. If a participant is removed for behavioral reasons, no refund will be issued and the participant may be blocked from future online sessions. Orlando Math Circle cannot provide refunds, credits, or transfers for any reason.

Parent Signature
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By signing, you acknowledge that you have read and agree to the above for myself and my child(ren) listed in this form
Do you want to start a math circle club in your school or in your neighborhood? *
What resources would be valuable  for you to receive from the Florida Math Circle Network? 
Is there anything else you want to share with us?
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