2024 RCBB - Fall Pickleball

RiverCity BuddyBall

2024 Fall Pickleball Season

Registration open through November 5th, or until at capacity

We're partnering up with the Autism Society of Central Virginia to bring you a 5-week season of pickleball! We will work on skills and drills, and then play games! Beginners and experienced friends of ALL abilities are welcome to try your hand at this popular sport.

Dates: Tuesdays, 11/12 - 12/17 (5-weeks)

Excluding Tuesday, 11/26 due to Thanksgiving

Time Slots:

5:00-6:00pm (ages 12-19) - FULL

6:00-7:00pm (ages 20-40)

Location: Cool Springs Baptist Church (9283 Atlee Station Rd, Mechanicsville, VA 23116)

Cost: $35

Ages: 12-40

Amount *	Quantity
$35 - Participant fee
$17.50 - Partial financial assistance
$0 - Total financial assistance

Refund Policy *

Jacob's Chance is able to process refunds upon request, up to one week prior to the start of the program/session, minus a 10% processing fee. We will not process refunds for fees below $10.

I acknowledge and accept the terms of the refund policy.

Optional Donation - Support the Mission!

$100

$50

$25

$10

Participant Information

Name *

First Name

Last Name

Birthdate *

(mm/dd/yyyy)

Participant Diagnosis *

Any accommodations requested/helpful tidbits? *

Is there anything we should know about the participant to ensure they have the most success possible? *IMPORTANT* - Per our policies, "we are unable to provide assistance with the following: toileting, wheelchair transfers, feeding, and any other ADLs." If your participant requires this type of assistance, a parent/guardian/caregiver must stay onsite the duration of the program. If you have any questions, please feel free to give us a call!

Does the participant have any allergies? (dietary or outdoor) *

Jacob's Chance will not administer any medication, so any rescue medication must be brought and administered by guardian/participant

Demographic Data *

Data collection is used only for grant compliance and internal review purposes. Check all that apply

Caucasian

Black or African American

Asian

Indigenous American or Native American

Native Hawaiian or Pacific Islander

Hispanic or Latino

Not of Hispanic Origin

Not interested in reporting

Gender Identity *

Data collection is used only for grant compliance and internal review purposes. Check all that apply

Male

Female

Non-binary

Other

Not interested in reporting

Requested pronouns (examples: he/him, they/them, she/her)

Family Contact Information

Parent/Guardian Name *

First Name

Last Name

Email *

Verify Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Policy Agreements/Waivers

Jacob’s Chance requires all participants, family members, caregivers, staff, board members, and volunteers to conduct themselves in a safe and respectful manner to help maintain a comfortable, safe, and fun environment. In order to engage in Jacob's Chance programs, everyone must read thoroughly and agree to the terms established by the documents below.

Jacob's Chance Code of Conduct

Jacob's Chance Program Policies

Jacob's Chance Risk, Media, & Concussion Waivers

I have read fully, and agree to the terms established by the waivers/policies linked above. *

Yes

Name of the person responding to the above waivers/policies, on behalf of the participant registered. *

First Name

Last Name

Add 3% to my total amount to help cover the payment processing fees

2024 RCBB - Fall Pickleball

2024 Fall Pickleball Season

Registration open through November 5th, or until at capacity

We're partnering up with the Autism Society of Central Virginia to bring you a 5-week season of pickleball! We will work on skills and drills, and then play games! Beginners and experienced friends of ALL abilities are welcome to try your hand at this popular sport.

Dates: Tuesdays, 11/12 - 12/17 (5-weeks)

*Excluding Tuesday, 11/26 due to Thanksgiving*

Time Slots:

5:00-6:00pm (ages 12-19) - FULL

6:00-7:00pm (ages 20-40)

Location: Cool Springs Baptist Church (9283 Atlee Station Rd, Mechanicsville, VA 23116)

Cost: $35

Ages: 12-40

Participant Information

Family Contact Information

Excluding Tuesday, 11/26 due to Thanksgiving