Iron Range Blast Registration Player Information Player's Full Name * Player's DOB * Current Association Level You're Playing At in 11-12 * Select One Mite-Peanut Squirt A Squirt B Peewee A Peewee B Bantam A Bantam B U10 A U10 B U12 A U12 B U14 A U14 B U16 A U16 B High School / JV High School / Varsity Team You're Registering For * Select One 1997 Iron Range Blast 1998 Iron Range Blast 1999 Iron Range Blast 2000 Iron Range Blast 2001 Iron Range Blast 2002 Iron Range Blast 2003-2004 Iron Range Blast U16 (95-96) Iron Range Blast U14 (97-98) Iron Range Blast U12 (99-00) Iron Range Blast U10 (01-02) Iron Range Blast Preferred Position * Select One Goalie Defenseman Forward Coaching Opportunities Select One Coach Assistant Coach Team Manager N/A Previous AAA Teams, If Any Accomplishments / Highlights From This Season Parent / Guardian Information Father's Name* Mother's Name* Home Phone* Cell Phone Email* Address* City* State* Zip* Release of Liability I/We understand that Northland Hockey Group, LLC et al does not carry insurance on its players. I agree to save, hold harmless and indemnify Northland Hockey Group, LLC, its officers, coaches, instructors, support and game staff from any injury my child may sustain while a participant. I also agree to possess health and dental insurance as a condition of my child's participation. I Agree* Parent or guardian signature: Send Request
