Player Information
Player NameLuke Small
Player's Date of Birth09/17/2018
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 9 - Johnston
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 NameJames Small
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone3085501131
2nd Parent / Guardian NameAshley Small
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4025258698
Billing Address27601 Broadwater Bay
Adams, NE 68301
United States
Map It
Total$250.00
Payment MethodPayPal Checkout