Player Information
Player NameSam Evans
Player's Date of Birth11/22/2019
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 10 - Borchers
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 NameTyler Evans
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4024996686
2nd Parent / Guardian NameKatelyn Evans
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4024290928
Billing Address6500 Pheasant Run Ct
Lincoln, NE 68516
United States
Map It
Total$250.00
Payment MethodPayPal Checkout