Player Information
Player NameBenjamin Ermisch
Player's Date of Birth08/03/2018
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 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 NameAlison Ermisch
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone916-478-1008
2nd Parent / Guardian NameSteve Ermisch
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone720-240-1594
Billing Address1500 W Big Sky Rd
Lincoln, NE 68521
United States
Map It
Total$250.00
Payment MethodPayPal Checkout