1st/2nd Grade Basketball CAMP Registration

CCCC 1st/2nd Grade Basketball Camp
Select Sport Program*
Participant Full Name*

First NameLast Name
Jersey Size *
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
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Volunteer (Parent/Guardian 1)

I would be interested in helping with campI’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.)
Second Parent/Guardian Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Volunteer (Parent/Guardian 2)

I would be interested in helping with campI’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.)
Additional Emergency Contact *

First NameLast Name
Phone Number*
Please enter a valid phone number.
As kids approach 3rd-4th grade, many groups start looking into travel ball. Indicate if you may be interested in learning about the community center's travel ball support agreement in preparation for this time.*

YES I would consider starting a travel team in the future and learning about how the center can support thatNO I do not plan on forming a travel team
3v3 basketball league will run in February. 2 days a week and practices and games will be combined into a set time. (30 min of practice, 30 min of game play) Coaches will register a team of 3-5 players. Please indicate if you are interested in coaching a 3v3 team this year.*

Yes, I would like to put in a teamNo, but my child is interested in finding a teamNone of the above
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
RELEASE OF LIABILITY – READ BEFORE SIGNING

In consideration of being allowed to participate in athletic competitions, practices, leagues, tournaments, training sessions, and all related activities organized by or associated with the Cheyenne County Community Center (CCCC) at the Community Center and at any off-site gym, school, field, park, or facility used for scheduled games or events, I, _______________________, the undersigned, acknowledge, appreciate, and agree that: Participation in athletic activities involves inherent risks, including but not limited to: slips, falls, collisions, equipment failure, contact with other participants, and other hazards that may result in injury, illness, permanent disability, or death. While rules, equipment, and personal discipline may reduce these risks, serious injury can occur; and, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation; and, I agree to follow all rules, instructions, and safety guidelines provided by the Cheyenne County Community Center staff, coaches, volunteers, and facility personnel. If I observe any unsafe condition or hazard at any location, I will remove myself from participation and immediately notify CCCC staff; and, I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Cheyenne County Community Center, its directors, officers, employees, volunteers, officials, coaches, event staff, other participants, sponsoring agencies, sponsors, advertisers, and any owners or operators of facilities or game sites used for athletic events (“Releasees”) from any and all claims of injury, disability, death, or loss or damage to person or property, arising out of my participation or presence at any athletic competition or activity, whether caused by the negligence of the Releasees or otherwise, to the fullest extent permitted by law.
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER 18 AT TIME OF REGISTRATION)

I certify that I am the parent/legal guardian of the minor participant named above and have legal responsibility for this child. I consent to their participation in athletic competitions and related activities at the Community Center and all off-site locations. I agree to the terms of this Release on behalf of myself, my child, and our heirs and assigns. I further agree to indemnify and hold harmless all Releasees from any and all claims arising from my child’s participation, even if caused by the negligence of the Releasees, to the fullest extent permitted by law.
Release of Liability - Please read before checking box below*

I have read and agree to these terms

NOTE!!! If you choose to participate in the 3v3 league as well, you will be charged $25 separately after your team's coach registers your team. Registration for 3v3 league will be open soon!

Pay By CardBasketball

$40.00 Quantity

Pay By Check/Cash $40

$ Free Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

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