Registration Type
*
Football
Cheer
Child's Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
My child resides in Louisa County
*
Birthdate
*
Birthdate cutoff is 8/1 for ALL DIVISIONS. Cannot be 15 or 9th grader.
For more information please visit jdyfl.org
MM
DD
YYYY
School
*
MNES
LCMS
JES
TJES
TES
Other (Please list below)
Other School *if applicable
Shirt Size
Child XS
Child S
Child M
Child L
Child XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Pant Size (Football Only)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Additional information
*
Are there any specific considerations, preferences, or information about your child that you would like LYAA coaches or staff to be aware of?
(This may include medical conditions, allergies, learning styles, behavioral or emotional needs, sensory sensitivities, communication preferences, family dynamics, or anything else that would help us create a supportive and positive experience for your child. All information will be kept confidential and shared only with relevant LYAA staff and coaches to support your child’s participation.)
Parent/Guardian 1 Name
*
First Name
Last Name
Parent/Guardian 1 Email
*
Parent/Guardian 1 Phone
*
(###)
###
####
Parent/Guardian 1 Relationship to Child
*
Coaching/Team Mom
*
Would you like to learn more about opportunities to support the team, such as coaching, becoming a team parent, or helping in another role?
Parent/Guardian 2 Name
*
First Name
Last Name
Parent/Guardian 2 Phone
*
(###)
###
####
Parent/Guardian 2 Email
*
Parent 2 Relationship to Child
*
Coaching/Team Mom
*
Would you like to learn more about opportunities to support the team, such as coaching, becoming a team parent, or helping in another role?
Media Release
*
I understand that LYAA may photograph or video participants during events, practices, and games for use in promotional materials such as social media, flyers, and the organization’s website.
If I do NOT want my child’s image or name used, I will email louisayouthathletics@gmail.com with my child’s full name to opt out.
Otherwise, I grant permission for the use of photos and videos as described above.
Medical (Football only)
*
A JDYFL Medical Release or VHSL Physical Form (FOOTBALL ONLY) must be completed by a licensed physician or nurse practitioner prior to the start of the season. These forms are available on your football team’s page at louisayouthathletics.com.
