Player Information
Player NameOwen Shaw
Player's Date of Birth09/14/2018
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 8 - Goodrich
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 NameNatasha Leppky
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4025405685
2nd Parent / Guardian NameBrian Shaw
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4024401387
Billing Address5730 South 50th Street
Lincoln, NE 68516
United States
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Total$250.00
Payment MethodPayPal Checkout