Leesville Youth Basketball Association - (Leesville, LA)

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2025-2026 Leesville Basketball Association Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Gender:

* Grade:

Check if registrant played last year

Last year Team name:

* Jersey/Shirt size:

* Age Before December 31, 2025:

Participants must present a copy of their birth certificate at the first scheduled practice!!

* Email address:

PARENT/GUARDIAN

* First name:

* Last name:

* Work Phone:

* Home Phone:

* Cell Phone:

Volunteer as a Coach or Assist Coach:

If anyone participate as a volunteer must be willing to agree to a background check for any prior offenses or convictions that may affect your ability to participate in this program involving young people!

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Leesville Youth Basketball Association terms & agreements:

I do hereby understand that by registering with and participation in Leesville Youth Basketball Association, I will complete a hold harmless agreement and a medical release before my child participate in any basketball activities. All participants must agree to conduct themselves in accordance with the principles of LYBA Codes of Conduct.

The information I submitted is correct and agree to the terms listed above. *

I prefer to complete the form online but pay using cash method

If you choose the cash payment method. Please call 337-353-6636 to set up payment arrangement

Payment to Cash App: $Lyba25679
Put kids name in subject line

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