Football Info Request

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LUYAA Youth Football Information Request Form

YES!
I'm interested in hearing more about LUYAA youth football for my child.

(Check all boxes that apply)
Please get me further Fall Football details when available
Please have someone call me at the number below
I'm interested in other LUYAA programs

Complete the form below, then click on the "Submit" button at the bottom.

Parent / Guardian's Name:
Street Address:
City:
State:
Zipcode:
Home Telephone:
E-Mail Address:
High School District:
1st Child's Name:
1st Child's Birthdate:
School 1st Child attends:
1st Child's football experience:
1st Child's Weight (approx.):	lbs.
2nd Child's Name:
2nd Child's Birthdate:
School 2nd Child attends:
2nd Child's football experience:
2nd Child's Weight (approx.):	lbs.
Comments / Specific questions: