Player Information
Player NameCrew Bergen
Player's Date of Birth09/13/2018
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 1 - 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 NameCarrie Bergen
Parent / Guardian EmailEmail hidden; Javascript is required.
Parent / Guardian Cell Phone4025600880
2nd Parent / Guardian NameMitch Bergen
2nd Parent / Guardian EmailEmail hidden; Javascript is required.
2nd Parent / Guardian Cell Phone4024292580
Billing Address3009 S 26th Street
Lincoln, Nebraska 68502
United States
Map It
Total$250.00
Payment MethodPayPal Checkout