Bucky's Impact Club Volleyball Camp 2026

Bucky's Impact Club Volleyball

Summer Camp 2026

July 20 - 23, 2026

INCOMING 6TH - 12TH GRADERS

REGISTRATIONS LIMITED!

Player 1 Name

First NameLast Name

Age

Date of Birth

Date

Grade (26/27 School Year)

School

T-Shirt Size:

SESSIONS:

AGE GROUP/TIMES:

Player 2 Name

First NameLast Name

Age

Date of Birth

Date

Grade (26/27 School Year)

School

T-Shirt Size:

SESSIONS:

AGE GROUP/TIMES:

Player 3 Name

First NameLast Name

Age

Date of Birth

Date

Grade (26/27 School Year)

School

T-Shirt Size:

SESSIONS:

AGE GROUP/TIMES:

Player 4 Name

First NameLast Name

Age

Date of Birth

Date

Grade (26/27 School Year)

School

T-Shirt Size:

SESSIONS:

AGE GROUP/TIMES:

Parent/Guardian

First NameLast Name

Parent/ Guardian Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Guardian/Parent Email:

Do you agree to receive email communications from our organization? If you check no, you may miss out on important information and opportunities.

CELL Phone (Best contact number for coaches)

Area CodePhone Number

Important Notes · Dress appropriately. · No OUTSIDE food or drink in the gyms. NO DOGS/ANIMALS · Keep the gym clean. · NO LAWN CHAIRS

ORGANIZERS RESERVE THE RIGHT TO REMOVE UNRULY PATRONS FROM ANY EVENT ASSOCIATED WITH BUCKY'S IMPACT CLUB VOLLEYBALL!

Emergency Contact Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Does your athlete have any allergies, chronic illness, or medical conditions that would limit high level activity?

Please describe

Parental Permission For Emergency Treatment In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to (LIST BELOW). I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

PARENT CODE OF CONDUCT:

NO OUTSIDE FOOD OR DRINKS ALLOWED...

AS A PARENT, COACH, or ADMINISTRATOR, I hereby pledge to provide positive support, care, and encouragement for my child and/or the athletes in BUCKY'S IMPACT CLUB VOLLEYBALL by following this Code of Conduct and ethics:
(1) I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game,
practice, or other youth sports event recognizing that youth and adult participation is a condition privilege and not a right.
(2) I will insist that my child and/or the athletes play in a safe and healthy environment. I acknowledge being trained on concussions
and head injuries, and I shall strictly following all concussion laws, rules, protocols, and full-contact practice limitations.
(3) I will require that my child's coaches, or those with whom I am working, be trained in the responsibilities of being a youth sports
coach and that coaches uphold this Code of Conduct, leading by example and being a mature responsible role model.
(4) I will support coaches and officials working with my child or athlete in order to encourage a positive and enjoyable experience for
all in a sports environment that is free from drugs, tobacco, and alcohol and I will refrain from their use at all youth sports events.
(5) I will remember that the game is a privilege for youth participants and athletes - not the adults.
(6) I will do my very best to make youth sports fun for my child and the athletes recognizing that winning is not the only goal -teaching my
child and the athletes the importance of team work and discipline is first and foremost. I will ask my child and the athletes to treat other
players, coaches, fans, and officials with respect regardless of race, sex, creed or ability and I will refrain from cursing, vulgar language and
any other detrimental or unsportsmanlike conduct understanding that I alone am responsible for my actions.
(7) I will help my child and the athletes enjoy the youth sports experience by doing whatever I can, such as being a respectful fan,
assisting with coaching, providing transportation, or otherwise assisting the team/organization.
(8) I will read the National Standards for Youth Sports, doing what I can to help BUCKY'S IMPACT CLUB VOLLEYBALL as well as all youth sports organizations
implement and enforce them.

Release of Liability Although the safety of all sports activities is the primary concern, indoor sport activities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Bucky's Impact Club Volleyball, Red Bluff Youth Expansion and any/or all persons associated with the organization either directly or indirectly during events sanctioned or associated with Bucky's Impact Club Volleyball or Red Bluff Youth Expansion. By signing below, I aknowledge my full understanding of the Release of Liability.

I have read and agree to the RELEASE OF LIABILITY AND PARENT CODE OF CONDUCT.

Signature:

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at rbyouthexpansion@gmail.com.

Registration Payments

ALL CAMP SESSIONS: JULY 20 - 23, 2026$80.00

PLEASE SELECT THIS OPTION IF YOUR ATHLETE IS PLANNING ON PARTICIPATING EVERY DAY OF CAMP!

Quantity
Item subtotal:

JULY 20 - BALL CONTROL/FLOOR DEFENSE$25.00

Quantity
Item subtotal:

JULY 21 - SETTING/HITTING/BLOCKING$25.00

Quantity

JULY 22 - SERVE/SERVE RECEIVE $25.00

Quantity

JULY 23 - SCRIMMAGES$25.00

Payment includes game t-shirt & player pack as well as registration for the season.

Quantity

CAMP T-SHIRT$15.00

Quantity

Enter coupon

Total $0.00

Payment Methods

Credit Card

Apple Pay

Parent/Guardian Information

Registration Payments*

Payment Methods

Registration Payments