Birthdate *

MM

DD

YYYY

Player's Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Photo Release *

I give the Albany Lady Falcons Basketball Club permission to use my child's name and picture on their website and any sponsor's website that is partnered with the program.

Yes