Player Information
Player NameHendrix Soulliere
Player's Date of Birth07/26/2019
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 9 - Johnston
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 NameMiranda Soulliere
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4024322014
2nd Parent / Guardian NameShaun Soulliere
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4028416098
Billing Address8110 Trendwood Dr
Lincoln, NE 68506
United States
Map It
Total$250.00
Payment MethodPayPal Checkout