Youth Basketball Interest Form
Child's Name
First Name
Last Name
Child's Age
Child's Gender
Parent's Name (1)
First Name
Last Name
Parent's Name (2)
First Name
Last Name
Parent (1) email
example@example.com
Parent (2) email
example@example.com
Phone Number (1)
Please enter a valid phone number.
Phone Number (2)
Please enter a valid phone number.
Name of the school your child attends?
Does your child have any special accommodations that we should know of?
Child's Basketball Skill Level
Please Select
Beginning
Intermediate
Advance
LFJCC Membership
Member
Non-member
Submit
Should be Empty: