Player Information
Player NameHowie Horak
Player's Date of Birth08/14/2018
Do you have another player to register?Yes
2nd Player's NameTheo Horak
2nd Player's Date of Birth12/06/2019
Do you have a player/coach that you would like to be on the same team with?Yes
Please enter the players/coaches namesTeam 7 - Wright
Player RegistrationPlayer 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 NameMatthew Horak
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone3083804042
2nd Parent / Guardian NameMadison Horak
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone3087502850
Billing Address4440 S 44th
Lincoln, NE 68516
United States
Map It
Total$500.00
Payment MethodPayPal Checkout