Minor Waiver & Medical Authorization Form 未成年兒童責任豁免及醫療授權書
Under Age 18/ 18歲以下
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

1. Purpose - To facilitate greater fellowship between brothers and sisters.
Building up the household of God through spiritual and physical activities.

2. Usages
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.
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.
1. Basketball
2. Volleyball
3. Badminton
4. Ping Pong
ii. All others recreation equipment are not permitted without prior approvals.
iii. Recreation equipments and supplies are not to be removed from
the OCCCAC without prior approvals.
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.

11. Membership
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 members (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 Christ-like conduct
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 hereby give permission to my child/children listed below to participate in the activities in the OCCCAC. I fully understand that my child/children is/are to abide by all the regulations and policies governing the usage and enjoyment of this facility. I understand that if my child/children has/have violated any of these regulations and policies, he or she may be sent home. I understand and acknowledge that by consenting to allow my child/children 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 my child’s/children's property that occurred in the OCCCAC. In the event that my child/children 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 of my child/children. It is understood that the resulting expenses will be the responsibility of the parent(s), guardian(s), or participant (whenever possible, attempts will be made to contact the parent/guardian prior to taking any medical action).
Child #1 兒童姓名 #1 (please print first and last name) *
Your answer
Child #2 兒童姓名 #2 (please print first and last name)
Your answer
Child #3 兒童姓名 #3 (please print first and last name)
Your answer
Child #4 兒童姓名 #4 (please print first and last name)
Your answer
Parent's Name 家長姓名 *
Your answer
Address 地址 (include city, state, and zip code) *
Your answer
E-mail Address 電子郵件地址
Your answer
Phone 電話 (xxx-xxx-xxxx) *
Your answer
In the event of illness or accident and unable to contact above, please contact 如果疾病或意外發生後,未能聯絡上列家長,請聯絡:
Emergency contact 緊急事故聯絡人 *
Your answer
Relationship 聯絡人關係 *
Your answer
Contact Address 聯絡人地址 (include city, state, and zip code) *
Your answer
Contact Phone 聯絡人電話 (xxx-xxx-xxxx) *
Your answer
Parent's Signature 家長簽名 (please print first and last name) By typing my name, it is the same as a legal signature confirming that I acknowledge and agree to the above terms of acceptance. 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 *
Your answer
Date 日期 (mm/dd/yyyy) *
Your answer
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