Player Information
Player NameEllis Menke
Player's Date of Birth04/14/2020
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 NameBrent Menke
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4022398113
2nd Parent / Guardian NameCaley Menke
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4025200637
Billing Address6184 Blackstone Rd
Lincoln, NE 68526
United States
Map It
Total$250.00
Payment MethodPayPal Checkout