Player Information
Player NameBarrett Blomker
Player's Date of Birth12/05/2018
Do you have another player to register?No
Do you have a player/coach that you would like to be on the same team with?Yes
Please enter the players/coaches namesTeam 3 - Puhl
Player RegistrationPlayer Registration, Qty: 1, 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 NameLindsay Blomker
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone402-314-4737
2nd Parent / Guardian NameCal Blomker
2nd Parent / Guardian Cell Phone402-826-7140
Billing Address7201 W Ranger Ridge Rd.
Lincoln, ne 68532
United States
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Total$250.00
Payment MethodPayPal Checkout