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League or Camp Option*

3rd & 4th Grade Volleyball

5th & 6th Grade Volleyball

3rd & 4th Grade Basketball

5th & 6th Grade Basketball

Are you a current club member?*

Yes

No

Participant Information

Participant Name*

First Middle Last

School*

Address*

Street Address Address Line 2 City State ZIP Code

Gender*

Grade*

Current Age*

Birthdate*

MM slash DD slash YYYY

T-shirt size*

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

NOTE: Jerseys run big

Parent/Guardian Information

Parent/Guardian Name*

First Last

Phone*

Email*

Interested In Coaching?

Yes

No

Primary coach’s child rate is 1/2 off. Please pay by cash or check if you are interested in becoming the coach to receive the discount if selected.

Payment

How Do You Plan on Paying?*

Check

Cash

Online Payment

Online Payment Fee

Price: $0.00

Total

Name (on Credit Card)*

First Middle Last

Email (For Payment)*

Address (On Credit Card)*

Street Address Address Line 2 City State ZIP Code

Credit Card*

Cardholder Name

Card Details

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Name

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Contact

925 N. Silverbrook Drive
West Bend, WI

(262) 334-3732

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