Clone of General form

CCCC Youth Sports Registration

TO REGISTER ONLINE, YOU MUST PAY ONLINE. TO REGISTER BY CHECK OR CASH YOU MUST COME IN TO THE COMMUNITY CENTER.
PLEASE ENSURE ALL INFORMATION IS CORRECT

Communications for basketball will be sent out after registration closes. Camp begins 10/19
Select Sport Program
Grade level
Participant Full Name

First NameLast Name
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Shirt Size
Please indicate if you have a roster request. the requests that will be accepted include: Siblings of the same age range, cousins, and kids that go to the same school outside of Sidney. State player and reason below:
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.Format: (000) 000-0000.
Email Address
example@example.com
Volunteer (Parent/Guardian 1)
Second Parent/Guardian Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Volunteer (Parent/Guardian 2)
Additional Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
If you have any siblings or family friends that would be willing to help referee or scorekeep please list their name and number below
travel league (this list will be shared with travel coaches so they know who is interested in traveling) My child...
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.
Release of Liability - Please read before checking box below
Please verify that you are human

My Products- TO REGISTER ONLINE, YOU MUST PAY ONLINE. TO REGISTER BY CHECK OR CASH YOU MUST COME IN TO THE COMMUNITY CENTER. IF YOU NEED TO DISCUSS PAYMENT ASSISTANCE OPTIONS PLEASE CALL US AT 308-254-7000

Camp & League

Basketball

$50.00 Quantity

CAMP ONLY

$30.00 Quantity

LEAGUE ONLY

$30.00 Quantity

Total

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

Country

Should be Empty:

CCCC Youth Sports Registration

PLEASE ENSURE ALL INFORMATION IS CORRECT

My Products- TO REGISTER ONLINE, YOU MUST PAY ONLINE. TO REGISTER BY CHECK OR CASH YOU MUST COME IN TO THE COMMUNITY CENTER. IF YOU NEED TO DISCUSS PAYMENT ASSISTANCE OPTIONS PLEASE CALL US AT 308-254-7000*

My Products- TO REGISTER ONLINE, YOU MUST PAY ONLINE. TO REGISTER BY CHECK OR CASH YOU MUST COME IN TO THE COMMUNITY CENTER. IF YOU NEED TO DISCUSS PAYMENT ASSISTANCE OPTIONS PLEASE CALL US AT 308-254-7000