2023 Middle School Camp Registration

River City Volleyball Summer Camp Registration

For the 2023 Summer Season
CONTACT INFORMATION
Athlete's Name*

First NameLast Name
Athlete's Phone Number
Athlete's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*
MM/DD Format: 06/24
T-Shirt Size*
Current School*
Grade entering in the fall*
Parent/Guardian Information
Parent/Guardian #1's Name*

First NameLast Name
Parent/Guardian #1's Cell Phone*
Parent/Guardian #1's Work Phone*
Parent/Guardian #1's Email*
This email will receive all updates and announcements.
Would you like to list another Parent/Guardian?*

YesNo
Parent/Guardian #2's Name

First NameLast Name
Parent/Guardian #2's Cell Phone
Parent/Guardian #2's Work Phone
Parent/Guardian #2's Email
Emergency Contact and Camper Release
Emergency Contact (Other than Parent/Guardian(s) listed)*

First NameLast Name
Cell Phone #*
Work Phone #
Camper Release*
List anyone, including parents, to whom your camper can be released

Health Information

It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If any information has changed between submission of this form and camp start date, please see a camp administrator or contact admin@rivercityvolleyballacademy.com
All fields below are required. If nothing applies, please type NONE in the box.

Thank you.
Is camper free from infectious disease or conditions?*

YesNo
Is there any activity the camper should be restricted from?*
Any physical, mental or other conditions that would require special attention or medication while at camp?*
Please list any allergies*
Ex: bees, peanut, dairy...

Please Acknowledge

Medical Release and Camp Rules
Medical Release:

I, on my own behalf and on behalf of the minor, acknowledge and agree that such participation subjects Minor to possibility of physical illness or injury (minimal, serious, catastrophic and/or death) and that I, on my own behalf and on behalf of the Minor, acknowledge that the Minor is in good health, physically fit and mentally capable of participating in Camp activities, and is covered by accident and health insurance, and I hereby give full approval for my child’s participation in the Camp. In the event of such illness or injury, I authorize Kevin Pond and Elizabeth Ellinger Pond to obtain necessary medical treatment of the Minor and hereby, on my own behalf and on behalf of the Minor, release and hold harmless releases in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of the Minor for any illness or injury that the Minor may sustain during the Camp and while traveling to and from the site for the Camp.
Parent/Guardian Signature*

Clear
Camp Rules:

I further acknowledge and understand that Kevin Pond and Elizabeth Ellinger Pond have established rules and regulations pertaining to conduct, behavior and activities of all Camp participants by which Minor and I agree to abide during the Camp), and that Minor and I will be responsible for his/her/my failure to abide by those rules and regulations. Minor and I have received, read and understand the Camp rules. Minor and I understand that violation of the rules can result in dismissal from Camp. By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites. I authorize Kevin Pond and Elizabeth Ellinger Pond to use my camper's picture, testimony, video in any promotional material (web,print,or media), and I may receive any e-mails from the camp.
Parent/Guardian Signature*

Clear

Payment Information
Please note that online payment prices include processing and service fees. If you wish to avoid these fees, cash and check payments are accepted.

Please ensure cash payments are placed in an envelope labeled with the Athlete's name and camp info and place it into the Check Box, located at the Academy.

Check payments may be made out to River City Volleyball Academy and can be placed in the Check Box or mailed. Checks must have Athlete's name and camp info notated on check or on the envelope.

Mailing Address: 11285 Silverstone Dr, Mechanicsville, VA 23116

Check and cash payments must be recevied one week PRIOR to the start of camp.

If you want to pay online, please pay here.

Online Payment
How do you wish to complete payment?*

Online Payment - includes processingCash or Check

What's Next?

The Parent/Guardian listed as #1 should receive a copy of your form submission. If you DO NOT, please reach out to us. That email is our point of contact with you on all updates and announcements regarding this summer!

If you have any questions, concerns or need to make changes to your request, please contact us at rcvaops@gmail.com

Can't wait to see you in July!

#RCVAIsWhereToPlay
Should be Empty:

River City Volleyball Summer Camp Registration

CONTACT INFORMATION

Parent/Guardian Information

Emergency Contact and Camper Release

Health Information

Please Acknowledge

Payment Information

What's Next?