2026 CCCC Youth Basketball Registration

CCCC Youth Basketball Registration

Boys Camp (Oct 20, 21, 23) Girls Camp (Oct 27, 28, 30) League November 15-December 13th (Saturdays)
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)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Second Parent/Guardian Full Name

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

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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- this list will be shared with travel coaches so they know who is interested in traveling) My child...
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.
Release of Liability - Please read before checking box below
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