Player Information
Player NameJack Burmood
Player's Date of Birth09/30/2018
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 namesCharles Legree, Coach Jeff Legree
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 NameDanielle Burmood
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4024690151
2nd Parent / Guardian NameAdam Burmood
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone3082381151
Billing Address2251 Grainger Parkway
Lincoln, NE 68512
United States
Map It
Total$250.00
Payment MethodPayPal Checkout