Player Information
Player NameGunner Barth
Player's Date of Birth12/24/2018
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?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 NameRachel Barth
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4024404211
2nd Parent / Guardian NameEric Barth
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4026416107
Billing Address10255 S 176
Bennet, Nebraska 68317
United States
Map It
Total$250.00
Payment MethodPayPal Checkout