2025 CCL/EYSA Basketball Cheer Registration Form
Please complete all sections of this form to register your child for basketball cheer. To register to play basketball, click here. Basketball cheer registration is $295.00 for new cheerleaders and $200.00 for returning cheerleaders who have uniforms from the prior season. If you need to order additional uniform pieces, please let the cheer director know. An itemized cost list will be provided to you. Ages for basketball cheer are 5-18 as of 12/31/2025. This form is required for all participants. Your physical signature will be required before your child is allowed to participate.  If you complete this information online, a printed pre-filled copy of your registration will be provided to you by the EYSA Cheer Director. Please visit www.eysacheerleading.org for additional information. Payment can be sent to $EYSACheerleading via Cash App; 804-216-4219 Zelle, or cash to the Cheer Director.
Sign in to Google to save your progress. Learn more
Email *
Basketball cheerleaders are required to wear All White Reebok Freestyle Hi shoes and slouch socks.
Slouch Socks (Visit Threddies.com for the extra thick slouch socks. Your local beauty supply stores will have thinner slouch socks and those are okay as well.)
Please indicate your child's cheer status for the 2025 basketball season below: *
MEDICAL FORM
COMPLETION OF THIS FORM WILL COVER YOUR CHILD AT ALL CCL EVENTS FOR THE CURRENT YEAR
Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Age on 12/31/2025 *
Elementary School Boundary *
Grade for 2025 Season *
Parent 1 -  Full Name *
Parent 1 -  Phone Number *
Parent 1 - Are you interested in becoming a team parent? Team Moms/Dads automatically serve on the Director's Advisory Board. Please see a detailed description of the Director's Advisory Board and additional committees below: *
Parent 1 - Please check committees in which you would like to serve. Please note that committee chairs are also members of the Director's Advisory Board. *
Required
Parent 2-  Full Name *
Parent 2 -  Phone Number *
Parent 2 - Are you interested in becoming a team parent? Team Moms/Dads automatically serve on the Director's Advisory Board. Please see a detailed description of the Director's Advisory Board and additional committees below: *
Parent 2 - Please check committees in which you would like to serve. Please note that committee chairs are also members of the Director's Advisory Board. *
Required
Size Information
Please select your child's uniform size from the sizing charts below. 
Measuring Your Child
Uniform Sizing Chart
Top
Skirt
Briefs
Warm Up Sizing Chart
Warm Up Top
Warm Up Pants
Shoe Size (Please specify whether sizes are Preschool (10.5-3.0), Grade School (3.5-7.0), or Women's. FOOTBALL SEASON ONLY. Basketball shoes are to be purchased separately by parents.
Shirt Size *
Contact Information
Street *
City *
State *
Zip *
Telephone Number *
EMERGENCY CONTACT INFORMATION
In the case of an emergency, please identify someone to call regarding your child.
Emergency Contact 1 -Name *
Emergency Contact 1 -Relationship *
Emergency Contact 1 - (Home) Telephone Number *
Emergency Contact 1 - (Business) Telephone Number *
EMERGENCY CONTACT 2
Emergency Contact 2 -Name *
Emergency Contact 2 -Relationship *
Emergency Contact 2 - (Home) Phone Number *
Emergency Contact 2 - (Business) Phone Number *
THIS FORM DOES NOT REQUIRE A PHYSICAL EXAMINATION
Please list ALL allergies: (If none, please list N/A.) *
Please list allergies to medication: (If none, please list N/A.) *
Please list medication which participant is currently taking: (If none, please list N/A.) *
Please make any necessary comments concerning physical condition, restrictions of participant, if any, etc: (If none, please list N/A.) *
INSURANCE INFORMATION: Please list name and address of insurance company that covers participant.
Please check if participant is NOT covered by an insurance policy. Please be aware that bills will be sent directly to parent or legal guardian.
Name of Insurance Company (If none, list N/A.) *
Policy Number (If none, list N/A.) *
Insurance Company Mailing Address (If none, list N/A.) *
Insurance Company City (If none, list N/A.) *
Insurance Company State (If none, list N/A.) *
Insurance Company Zip (If none, list N/A.) *
Name of Subscriber (If none, list N/A.) *
Relationship to Participant (If you answered N/A to the question above, please list N/A below.) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms