CCCC Youth Basketball Registration

CCCC Youth Basketball Registration
Select Sport Program*
Participant Full Name*

First NameLast Name
Birthdate *

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School attending *
First Parent/Guardian Full Name*

First NameLast Name
Email Address*
example@example.com
Volunteer (Parent/Guardian 1)

I would like to head coach a teamI can assistant coachI am familiar with the sport and happy to help when I canI’m interested in joining the basketball committee to volunteer and advocate for the players and teams, help plan events, and assist with promotional content. (Committees meet 3–4 times a year.)
Phone Number*
Please enter a valid phone number.
Second Parent/Guardian Full Name

First NameLast Name
Email Address
example@example.com
Volunteer (Parent/Guardian 2)

I would like to head coach a teamI can assistant coachI am familiar with the sport and happy to help when I canI’m interested in joining the basketball committee to volunteer and advocate for the players and teams, help plan events, and assist with promotional content. (Committees meet 3–4 times a year.)
Phone Number
Please enter a valid phone number.
Additional Emergency Contact *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Please indicate if you have a roster request (i.e cousins to be put together) (we will only accept requests for kids that are related and in the same age group) indicate child and relationship to child below
travel league (January-March) My child...*

is playing travel basketballis interested in trying out for a travel teamis not going to play travel ball this year
Jersey Size *
Media Release

By signing this form, I give permission for the Cheyenne County Community Center to use photos, videos, or digital images of my child for: Social media posts (Facebook, Instagram, etc.) The official Cheyenne County Community Center website
I understand that:

- My child’s name will not be used with their image unless I provide separate written consent.
- Images will be used only in a positive manner to promote programs and activities.
- This consent is voluntary, and I may revoke it in writing at any time by contacting the Cheyenne County Community Center.
Yes I grant permission for my child's image to be used as describedNo, I do not grant permission for my child's image to be used
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I have read and agree to these terms
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