| Player Information | |
|---|---|
| Player Name | Cash Loeffel |
| Player's Date of Birth | 06/25/2019 |
| 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 |
| Please enter the players/coaches names | Team 10 - Evans |
| Player Registration | Player 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 Name | Natalie Loeffel |
| Parent / Guardian Email | Email hidden; Javascript is required. |
| Parent / Guardian Cell Phone | 4027700606 |
| 2nd Parent / Guardian Name | Tim Loeffel |
| 2nd Parent / Guardian Email | Email hidden; Javascript is required. |
| 2nd Parent / Guardian Cell Phone | 4025704774 |
| Billing Address | 8259 Emery Ln Lincoln, NE 68516 United States Map It |
| Total | $250.00 |
| Payment Method | PayPal Checkout |
By submitting this I accept the terms of the aforementioned Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement.