Player Information
Player NameJackson Herman
Player's Date of Birth07/10/2019
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 namesBarrett Bostwick
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 NameJ.D. Herman
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4022132221
2nd Parent / Guardian NameDeanna Herman
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4026391077
Billing Address4920 S 57th St
Lincoln, NE 68516
United States
Map It
Total$250.00
Payment MethodPayPal Checkout