| Player Information | |
|---|---|
| Player Name | Howie Horak |
| Player's Date of Birth | 08/14/2018 |
| Do you have another player to register? | Yes |
| 2nd Player's Name | Theo Horak |
| 2nd Player's Date of Birth | 12/06/2019 |
| Do you have a player/coach that you would like to be on the same team with? | Yes |
| Please enter the players/coaches names | Team 7 - Wright |
| Player Registration | Player Registration, Qty: 2, Price: $250.00 |
| Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement | By submitting this I accept the terms of the aforementioned Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement. |
| Parent-Guardian Information | |
| Parent / Guardian Name | Matthew Horak |
| Parent / Guardian Email | Email hidden; Javascript is required. |
| Parent / Guardian Cell Phone | 3083804042 |
| 2nd Parent / Guardian Name | Madison Horak |
| 2nd Parent / Guardian Email | Email hidden; Javascript is required. |
| 2nd Parent / Guardian Cell Phone | 3087502850 |
| Billing Address | 4440 S 44th Lincoln, NE 68516 United States Map It |
| Total | $500.00 |
| Payment Method | PayPal Checkout |
By submitting this I accept the terms of the aforementioned Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement.