Ben Bergstrom

168,5,2014-07-05 17:55:22,0,0,,,,USD,Approved,2014-07-05 17:55:22,6310876572,200,,1,,1,Mozilla/5.0 (Windows NT 6.2; WOW64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/35.0.1916.153 Safari/537.36,active,Under Armour Elite Passing Academy presented by The Quarterback Ranch and Rich Bartel,5th grade through 8th grade (Fall 2014 grade),Quarterback,Price,$400.00,1,2,Ben Bergstrom,6/1/2001,5′ 3″,110,Adult Small,7 (2014-15),Carroll Middle School (2014-15),Carroll Independent School District,626 Castle Rock Dr.,Southlake,Texas,76092,United States,Cathy Bergstrom,(817)657-8270,(817)657-8270,,
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.,50OFFUA,626 Castle Rock Dr.,Southlake,Texas,76092,United States,XXXXXXXXXXXX1339,MasterCard,Create an account?,cathyb99,,200,,,,,,,,,,,,,,,,,,,,,,,,,,