Player Information
Player NameHendrix Fields
Player's Date of Birth11/05/2018
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?No
Please enter the players/coaches namesTeam 5 - Buresh
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 NameMya Fields
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone7064643958
2nd Parent / Guardian NameHaven
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
Billing Address3409 Tree Line Drive
Lincoln, NE 68516
United States
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Total$250.00