Player Information
Player NameCarter Wiebe
Player's Date of Birth06/15/2019
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?Yes
Please enter the players/coaches namesTeam 2 - Anderson
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 NameDerrick Wiebe
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone402-429-1298
2nd Parent / Guardian NameSara Wiebe
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone402-890-0084
Billing Address7919 S 35th St
Lincoln, NE 68516
United States
Map It
Total$250.00
Payment MethodPayPal Checkout