CCCC Spring Soccer Registration

Select grade level *

Player Full Name*

First NameLast Name

Birthdate *

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

Phone Number*

Please enter a valid phone number.

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 Soccer 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.) WE NEED SOCCER COMMITTEE MEMBERS!

Second Parent/Guardian Full Name- This person will be added to the team communication

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 soccer 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.) WE NEED SOCCER COMMITTEE MEMBERS!

Phone Number

Please enter a valid phone number.

Additional Emergency Contact- This person will not be added to team communication unless also listed below- This is only for emergencies if parents can't be reached*

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 or parents are coaching together) indicate child and relationship to child below

Shirt size *

Please include any additional email addresses of any family members that need to be added to the team group where messages are exchanged between the coach and family. We will be using GameChanger for these communications.

Media Release

By completing 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.

Media Release*

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 - Please read before checking box below*

I have read and agree to these terms

My Products

Pay By Card2026 Soccer

$45.00 Quantity

Pay By Check/Cash $45

$ 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

Country

Please verify that you are human*

CCCC Youth Soccer Registration