Player Information Player's Name*
First
Last
Player's DOB* Player's Height* Player's Weight in pounds*
Team You're Registering For* Select One Borderland Rage Black Hills Blaze Chicago Wind Coyotes East Metro Lakers Fighting Loons Fighting Saints Great Lakes Gulls Ice Bucks Iowa Panthers Iowa Storm Iron Range Blast Montana Vipers Nebraska Trailblazers North Dakota Black Knights NoDak Oilers Predators Red River Pike Rum River Renegades Sabres Sodak Solar Bears South Dakota Kings Twin Cities Blast Twin Cities Vulcans Twin Cities XTREME West Central Minnesota Wolverines Wisconsin Crush Sioux Falls Solar Bears
Select Borderland Rage Team* Select One 2002 Borderland Rage 2003 Borderland Rage 2004 Borderland Rage 2005 Borderland Rage 2006 Borderland Rage 2007 Borderland Rage 2008 Borderland Rage 2009/10 Borderland Rage 16U Borderland Rage 14U Borderland Rage 12U Borderland Rage 10U Borderland Rage
Select Black Hills Blaze Team* Select One 2002 Black Hills Blaze 2003 Black Hills Blaze 2004 Black Hills Blaze 2005 Black Hills Blaze 2006 Black Hills Blaze 2007 Black Hills Blaze 2008 Black Hills Blaze 2009/10 Black Hills Blaze 16U Black Hills Blaze 14U Black Hills Blaze 12U Black Hills Blaze 10U Black Hills Blaze
Select East Metro Lakers Team* Select One 2002 Lakers 2003 Lakers 2004 Lakers 2005 Lakers 2006 Lakers 2007 Lakers 2008 Lakers 2009/10 Lakers 16U Lakers 14U Lakers 12U Lakers 10U Lakers
Select Fighting Loons Team* Select One 2002 Fighting Loons 2003 Fighting Loons 2004 Fighting Loons 2005 Fighting Loons 2006 Fighting Loons 2007 Fighting Loons 2008 Fighting Loons 2009/10 Fighting Loons 16U Fighting Loons 14U Fighting Loons 12U Fighting Loons 10U Fighting Loons
Select Fighting Saints Team* Select One 2003 Fighting Saints
Select Great Lakes Gulls Team* Select One 2002 Great Lakes Gulls 2003 Great Lakes Gulls 2004 Great Lakes Gulls 2005 Great Lakes Gulls 2006 Great Lakes Gulls 2007 Great Lakes Gulls 2008 Great Lakes Gulls 2009/10 Great Lakes Gulls 16U Great Lakes Gulls 14U Great Lakes Gulls 12U Great Lakes Gulls 10U Great Lakes Gulls
Select Ice Bucks Team* Select One 2002 Ice Bucks 2003 Ice Bucks 2004 Ice Bucks 2005 Ice Bucks 2006 Ice Bucks 2007 Ice Bucks 2008 Ice Bucks 2009/10 Ice Bucks 16U Ice Bucks 14U Ice Bucks 12U Ice Bucks 10U Ice Bucks
Select Iowa Panthers Team* Select One 2002 Panthers 2003 Panthers 2004 Panthers 2005 Panthers 2006 Panthers 2007 Panthers 2008 Panthers 2009/10 Panthers 10U Panthers 12U Panthers 14U Panthers 16U Panthers
Select Iowa Storm Team* Select One 2002 Iowa Storm 2003 Iowa Storm 2004 Iowa Storm 2005 Iowa Storm 2006 Iowa Storm 2007 Iowa Storm 2008 Iowa Storm 2009/10 Iowa Storm 16U Iowa Storm 14U Iowa Storm 12U Iowa Storm 10U Iowa Storm
Select Iron Range Blast Team* Select One 2002 Iron Range Blast 2003 Iron Range Blast 2004 Iron Range Blast 2005 Iron Range Blast 2006 Iron Range Blast 2007 Iron Range Blast 2008 Iron Range Blast 2009/10 Iron Range Blast 16U Iron Range Blast 14U Iron Range Blast 12U Iron Range Blast 10U Iron Range Blast
Select Montana Vipers Team* Select One 2003 Montana Vipers 2005 Montana Vipers 2007 Montana Vipers
Select Sabres Team* Select One 2002 Sabres 2003 Sabres 2004 Sabres 2005 Sabres 2006 Sabres 2007 Sabres 2008 Sabres 2009/10 Sabres 16U Sabres 14U Sabres 12U Sabres 10U Sabres
Select Nebraska Trail Blazers Team* Select One 2002 Nebraska Trail Blazers 2003 Nebraska Trail Blazers 2004 Nebraska Trail Blazers 2005 Nebraska Trail Blazers 2006 Nebraska Trail Blazers 2007 Nebraska Trail Blazers 2008 Nebraska Trail Blazers 2009/10 Nebraska Trail Blazers 16U Nebraska Trail Blazers 14U Nebraska Trail Blazers 12U Nebraska Trail Blazers 10U Nebraska Trail Blazers
Select Coyotes Team* Select One 2002 Coyotes 2003 Coyotes 2004 Coyotes 2005 Coyotes 2006 Coyotes 2007 Coyotes 2008 Coyotes 2009/10 Coyotes 16U Coyotes 14U Coyotes 12U Coyotes 10U Coyotes
Select North Dakota Black Knights* Select One 2002 North Dakota Black Knights 2003 North Dakota Black Knights 2004 North Dakota Black Knights 2005 North Dakota Black Knights 2006 North Dakota Black Knights 2007 North Dakota Black Knights 2008 North Dakota Black Knights 2009/10 North Dakota Black Knights 16U North Dakota Black Knights 14U North Dakota Black Knights 12U North Dakota Black Knights 10U North Dakota Black Knights
Select NoDak Oilers Team* Select One 2002 NoDak Oilers 2003 NoDak Oilers 2004 NoDak Oilers 2005 NoDak Oilers 2006 NoDak Oilers 2007 NoDak Oilers 2008 NoDak Oilers 2009/10 NoDak Oilers 16U NoDak Oilers 14U NoDak Oilers 12U NoDak Oilers 10U NoDak Oilers
Select Predators Team* Select One 2002 Predators 2003 Predators 2004 Predators 2005 Predators 2006 Predators 2007 Predators 2008 Predators 2009/10 Predators 16U Predators 14U Predators 12U Predators 10U Predators
Select Red River Pike Team* Select One 2002 Red River Pike 2003 Red River Pike 2004 Red River Pike 2005 Red River Pike 2006 Red River Pike 2007 Red River Pike 2008 Red River Pike 2009/10 Red River Pike 16U Red River Pike 14U Red River Pike 12U Red River Pike 10U Red River Pike
Select Rum River Renegades Team* Select One 2002 Rum River Renegades 2003 Rum River Renegades 2004 Rum River Renegades 2005 Rum River Renegades 2006 Rum River Renegades 2007 Rum River Renegades 2008 Rum River Renegades 2009/10 Rum River Renegades 16U Rum River Renegades 14U Rum River Renegades 12U Rum River Renegades 10U Rum River Renegades
Select Sodak Solar Bears Team* Select One 2002 Solar Bears 2003 Solar Bears 2004 Solar Bears 2005 Solar Bears 2006 Solar Bears 2007 Solar Bears 2008 Solar Bears 2009/10 Solar Bears 16U Solar Bears 14U Solar Bears 12U Solar Bears 10U Solar Bears
Select SD Kings Team* Select One 2004 SD Kings 2006 SD Kings 2007 SD Kings
Select Twin Cities Blast Team* Select One 2002 Twin Cities Blast 2003 Twin Cities Blast 2004 Twin Cities Blast 2005 Twin Cities Blast 2006 Twin Cities Blast 2007 Twin Cities Blast 2008 Twin Cities Blast 2009/10 Twin Cities Blast 16U Twin Cities Blast 14U Twin Cities Blast 12U Twin Cities Blast 10U Twin Cities Blast
Select Twin Cities Vulcans Team* Select One 2002 Twin Cities Vulcans 2003 Twin Cities Vulcans 2004 Twin Cities Vulcans 2005 Twin Cities Vulcans 2006 Twin Cities Vulcans 2007 Twin Cities Vulcans 2008 Twin Cities Vulcans 2009/10 Twin Cities Vulcans 16U Twin Cities Vulcans 14U Twin Cities Vulcans 12U Twin Cities Vulcans 10U Twin Cities Vulcans
Select Twin Cities XTREME Team* Select One 2002 Twin Cities XTREME 2003 Twin Cities XTREME 2004 Twin Cities XTREME 2005 Twin Cities XTREME 2006 Twin Cities XTREME 2007 Twin Cities XTREME 2008 Twin Cities XTREME 2009/10 Twin Cities XTREME 16U Twin Cities XTREME 14U Twin Cities XTREME 12U Twin Cities XTREME 10U Twin Cities XTREME
Select West Central Minnesota Wolverines Team* Select One 2002 MN Wolverines 2003 MN Wolverines 2004 MN Wolverines 2005 MN Wolverines 2006 MN Wolverines 2007 MN Wolverines 2008 MN Wolverines 2009/10 MN Wolverines 16U MN Wolverines 14U MN Wolverines 12U MN Wolverines 10U MN Wolverines
Select Wisconsin Crush Team* Select One 2002 Crush 2003 Crush 2004 Crush 2005 Crush 2006 Crush 2007 Crush 2008 Crush 2009/10 Crush 16U Crush 14U Crush 12U Crush 10U Crush
Select Chicago Wind Team* Select One 2002 Chicago Wind 2003 Chicago Wind 2004 Chicago Wind 2005 Chicago Wind 2006 Chicago Wind 2007 Chicago Wind 2008 Chicago Wind 2010/09 Chicago Wind 16U Chicago Wind 14U Chicago Wind 12U Chicago Wind 10U Chiacgo Wind
Select Sioux Falls Solar Bears Team* Select One 2002 Sioux Falls Solar Bears
Level You're Playing At in 2018-19* Select One Mite Squirt A Squirt B Peewee A Peewee B Bantam A Bantam B 10U A 10U B 12U A 12U B 14U A 14U B 16U A 16U B High School / JV High School / Varsity
Preferred Position* Select One Goalie Defenseman Forward
Returning Player* Select One Yes No
Current Association*
Coach/Manager Opportunities Select One If Interested Coach Assistant Coach Team Manager
Previous AAA Teams, If Any
Accomplishments / Highlights From This Season
Parent / Guardian Information Father's Name*
First
Last
Father's Phone*
Mother's Name*
First
Last
Mother's Phone*
Primary Email*
Address*
Release of Liability 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.
Parent or Guardian Signature* Payment Information If you are paying your balance please go to make a payment on top right.
No refunds given after March 1st or unless child does not make team.
Iron Range Blast Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Black Hills Blaze Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Montana Vipers Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Twin Cities Blast Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Coyotes Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Great Lakes Gulls Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Ice Bucks Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
East Metro Lakers Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Fighting Loons Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Fighting Saints Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Rum River Renegades Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Twin Cities Vulcans Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Wolverines Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Twin Cities Xtrerme Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Sabres Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Iowa Panthers Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Iowa Storm Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
SoDak Solar Bears Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
South Dakota Kings Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Sioux Falls Solar Bears Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Nebraska Trail Blazers Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
North Dakota Black Knights Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
NoDak Oilers Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Red River Pike Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Predators Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Borderland Rage Registration* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Wisconsin Crush Registraion* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Chicago Wind Registraion* Select the amount you are paying at time of registration. At minimum a deposit of $75.00 (US) is required to register and be considered for the team. You may pay the full fee if desired. If a player is not selected for a team a full refund will be issued. No refunds after March 1st, 2018.
Total
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