Riptide Volleyball Summer Camps 2022

June 6-8

1 Day ($100) 2 Days ($190) 3 Days ($280)

July 11-13

1 Day ($100) 2 Days ($190) 3 Days ($280)

Aug 1-3

1 Day ($100) 2 Days ($190) 3 Days ($280)

Registration and payment due one week prior to session start.

June session: Due May 30th

July session: Due July 4th

August session: Due July 25th

Payment Type *

Zelle Venmo Cash Check

Athlete Information

Athlete's Name *

First Name Last Name

Birth Date *

Month Day Year

Grade

Gender

Male Female

Shirt Size *

*Include whether sizes are adult or youth*

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian Information

Name *

First Name Last Name

E-mail *

example@example.com

Home Number

Area Code Phone Number

Cell Number *

Area Code Phone Number

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Riptide Volleyball LLC during the selected camp. In exchange for the acceptance of said child’s candidacy by RBVC.org., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless RBVC.org . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against RBVC.org , including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including volleyball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the RBVC.org staff . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Full Name *

First Name Last Name

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Full Name *

First Name Last Name

Riptide will supply drinks, lunch and snacks plus a gift bag!!