Patrick Dembiec

57,5,2014-04-24 14:59:45,0,0,,,,USD,Approved,2014-04-24 14:59:46,6119517130,400,,1,,1,Mozilla/5.0 (Windows NT 6.1; WOW64; Trident/7.0; rv:11.0) like Gecko,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,Patrick Dembiec,11/19/00,5’3,100,Adult Medium,8th,Carroll Middle School,CISD,Basebal,Basketbal,Other,904 Lexington Terrace,Southlake,Texas,76092,United States,Vicki Dembiec,(817)337-4803,(908)347-9638,,
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.,904 Lexington Terrace,Southlake,Texas,76092,United States,XXXXXXXXXXX6005,American Express,Create an account?,,,400,,,,,,,,,,,,,,,,,,,,,,