Player Information
Player NameGriffyn Burkhardt
Player's Date of Birth10/14/2019
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?No
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 NameCody Burkhardt
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone402-499-5854
2nd Parent / Guardian NameHaley Burkhardt
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone402-499-1857
Billing Address1636 Superior Road
Pleasant Dale, NE 68423
United States
Map It
Total$250.00
Payment MethodPayPal Checkout