Player Information
Player NameAustin Kerkman
Player's Date of Birth10/19/2018
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 3 - Puhl
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 NameAnne Kerkman
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone402-304-3165
2nd Parent / Guardian NameTravis Kerkman
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone402-499-2450
Billing Address2720 S 75th St
Lincoln, NE 68506
United States
Map It
Total$250.00
Payment MethodPayPal Checkout