Adult Waiver & Medical Authorization Form 成人責任豁免及醫療授權書
Orlando Chinese Church 奧蘭多中華教會
2230 Rouse Rd.
Orlando, FL 32817
Regulations and Policies
Orlando Chinese Church Christian Activity Center (OCCCAC) Regulations and Policies
To facilitate greater fellowship between brothers and sisters.
Building up the household of God through spiritual and physical activities
a. Schedule of Operation
i. By Reservation: Saturday 9:00am – 6:00pm
ii. Open Time: Sunday 3:30pm – 6:00pm
iii. All other times will be scheduled prior to activities and subject to review.
iv. All ballgames are limited to half court during open time except by approval
of the manager or Volunteer Staff.
v. Church scheduled activities shall take priority and over all usage reserved or unreserved.
vi. Reservation schedule maintained by the manager.
vii. If no Volunteer Staff is available the OCCCAC shall be closed.
b. Manager & Volunteer Staff
i. One manager to manage the usage of OCCCAC for recreation activity.
This manager will be appointed by the responsible brothers
and reports to the responsible brothers.
ii. Several volunteer staffs to supervise the recreation activity. These volunteer staffs will
be recruited by the OCCCAC
manager and report to the OCCCAC manager.
iii. Volunteer staffs will be scheduled for the time slots above.
c. Recreation Type /Equipment
i. The CAC gymnasium is design for the following recreation equipment.
4. Ping Pong
ii. All other recreation equipment are not permitted without prior approval.
iii. Recreation equipments and supplies are not to be removed from the
OCCCAC without prior approval.
iv. Shoes are required. Tennis or basketball shoes are to be worn during all recreation
activities in the gymnasium to avoid injury.
3. Use the front door facing Rouse Road for entry and exit. Do not use the gymnasium
doors for entry or exit.
4. Guests and members are not allowed to enter any storage area.
5. Kitchen use is limited to temporary usage of the refrigerator
for the duration your time here.
6. Eating and drinking should be limited to the kitchen area.
i. Only water is allowed in the gymnasium.
ii. No chewing gum in the gymnasium.
7. Kitchen equipment usage requires prior approval and training.
8. Do not use storage rooms or kitchen to store any personal item.
9. Report to the volunteer staff on duty first, if any damage or emergency happened.
10. Any item damaged or lost must be replaced by the individual or group responsible.
i. OCCCAC is open to members of Orlando Chinese Church and their guests.
Each member can bring three guests or obtain a permission through the manager
to bring more guests.
ii. Guests shall come with a member and leave with that member.
The sponsoring member is responsible for their guest's conduct
at all times while inside the Center.
iii. Children under age 12 shall be accompanied by a parent or guardian or adult member
(e.g. Sunday school teacher) in order to use the facility.
iv. In order to use the facility, the member and their guests have to sign a
Waiver & Medical Authorization Form. If any medical treatment or emergency service
is required, the injured member or guest shall be responsible for
the fee charged by the service provider.
12. Conduct & Behavior - This is a Church:
i. Every member and guest shall conduct himself/herself in a manner which would exhibit
ii. Dress should be modest and appropriate for the sporting activities.
The volunteer staff has the authority to ask the members or guests to change
the inappropriate dress.
iii. No smoking or any kind of alcohol drink is allowed anywhere in the facilities
including outside of the building.
iv. Stay inside the Center. Do not hang around outside or in parked automobiles.
v. Fighting, inappropriate languages and damage to properties and behaviors that causes
injuries will lead to the lost of privileges to use the OCCCAC.
vi. Members and guests shall clean up and leaving the facility as they found it for
the next members and guests.
Obey all rules. Do not treat them as nuisance or trouble. Do not give other the same impression.
Waiver And Medical Authorization
I have read the OCCCAC Regulations and Policies from above. I agree and shall abide by all the regulations and policies governing the usage and enjoyment of the OCCCAC. I understand that if I violated any of these regulations and policies, I will be asked to leave the property of Orlando Chinese Church immediately. I understand and acknowledge that by consenting to participate in the OCCCAC activities, I shall, by law be deemed to have waived any and all claims against Orlando Chinese Church and each of its officers, employees and agents (hereinafter collectively referred to as “OCC”) for any injury, accident, illness or death that occurred in the OCCCAC. I also agree to relieve OCC of any responsibility for damage to or loss of property that occurred in the OCCCAC. In the event I suffered an injury or illness, I hereby consent to whatever x-ray, examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for the safety and welfare. It is understood that the resulting expenses will be my responsibility.
Phone 電話 (xxx-xxx-xxxx)
E-mail Address 電子郵件地址
Address 地址 (include city, state, and zip code)
Emergency contact 緊急事故聯絡人
Contact Address 聯絡人地址 (include city, state, and zip code)
Contact Phone 聯絡人電話 (xxx-xxx-xxxx)
Introduced by if you are not OCC member 介紹人
Signature 簽名 : By typing my name, it is the same as a legal signature confirming that I acknowledge and agree to the above terms of acceptance. 上面輸入的我的名字，等同一個法定簽名，確認我承認並同意上述條款
Date 日期 (mm/dd/yyyy)
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