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 NW MN Bears Black Hills Blaze Midsota Lakers Chicago Wind Coyotes East Metro Lakers Fighting Loons Frostbite Great Lakes Gulls Ice Bucks Iowa Panthers Iowa Storm Iron Range Blast Metro Fighting Loons Montana Vipers Minnesota Black Knights Minnesota Crusaders Nebraska Bugeaters Nebraska Trailblazers North Dakota Crusaders North Dakota Black Knights Northland Moose North Metro Wild North Stars NoDak Oilers Predators Red River Pike Rum River Renegades Sabres Sodak Solar Bears Twin Cities Blast Twin Cities Vulcans Twin Cities XTREME Voyageurs West Central Minnesota Wolverines Wisconsin Crush
Select Black Hills Blaze Team* Select One 2004 Black Hills Blaze 2005 Black Hills Blaze 2006 Black Hills Blaze 2007 Black Hills Blaze 2008 Black Hills Blaze 2009 Black Hills Blaze 2010 Black Hills Blaze 2012/11 Black Hills Blaze 16U Black Hills Blaze 14U Black Hills Blaze 12U Black Hills Blaze 10U Black Hills Blaze
Select Midsota Lakers Team* Select One 2004 Midsota Lakers 2005 Midsota Lakers 2006 Midsota Lakers 2007 Midsota Lakers 2008 Midsota Lakers 2009 Midsota Lakers 2010 Midsota Lakers 2012/11 Midsota Lakers 16U Midsota Lakers 14U Midsota Lakers 12U Midsota Lakers 10U Midsota Lakers
Select East Metro Lakers Team* Select One 2004 East Metro Lakers 2005 East Metro Lakers 2006 East Metro Lakers 2007 East Metro Lakers 2008 East Metro Lakers 2009 East Metro Lakers 2010 East Metro Lakers 2012/11 East Metro Lakers 16U East Metro Lakers 14U East Metro Lakers 12U East Metro Lakers 10U East Metro Lakers
Select Fighting Loons Team* Select One 2004 Fighting Loons 2005 Fighting Loons 2006 Fighting Loons 2007 Fighting Loons 2008 Fighting Loons 2009 Fighting Loons 2010 Fighting Loons 2012/11 Fighting Loons 16U Fighting Loons 14U Fighting Loons 12U Fighting Loons 10U Fighting Loons
Select Frostbite Team* Select One 2004 Frostbite 2005 Frostbite 2006 Frostbite 2007 Frostbite 2008 Frostbite 2009 Frostbite 2010 Frostbite 2012/11 Frostbite 10U Frostbite 12U Frostbite 14U Frostbite 16U Frostbite
Select Ice Bucks Team* Select One 2004 Ice Bucks 2005 Ice Bucks 2006 Ice Bucks 2007 Ice Bucks 2008 Ice Bucks 2009 Ice Bucks 2010 Ice Bucks 2012/11 Ice Bucks 16U Ice Bucks 14U Ice Bucks 12U Ice Bucks 10U Ice Bucks
Select Iowa Panthers Team* Select One 2004 Panthers 2005 Panthers 2006 Panthers 2007 Panthers 2008 Panthers 2009 Panthers 2010 Panthers 2012/11 Panthers 10U Panthers 12U Panthers 14U Panthers 16U Panthers
Select Iowa Storm Team* Select One 2004 Iowa Storm 2005 Iowa Storm 2006 Iowa Storm 2007 Iowa Storm 2008 Iowa Storm 2009 Iowa Storm 2010 Iowa Storm 2012/11 Iowa Storm 16U Iowa Storm 14U Iowa Storm 12U Iowa Storm 10U Iowa Storm
Select Iron Range Blast Team* Select One 2004 Iron Range Blast 2005 Iron Range Blast 2006 Iron Range Blast 2007 Iron Range Blast 2008 Iron Range Blast 2009 Iron Range Blast 2010 Iron Range Blast 2012/11 Iron Range Blast 16U Iron Range Blast 14U Iron Range Blast 12U Iron Range Blast 10U Iron Range Blast
Select Metro Fighting Loons Team* Select One 2008 Metro Fighting Loons
Select Montana Vipers Team* Select One 2004 Montana Vipers 2005 Montana Vipers 2006 Montana Vipers 2007 Montana Vipers 2008 Montana Vipers 2009 Montana Vipers 2010 Montana Vipers 2012/11 Montana Vipers 16U Montana Vipers 14U Montana Vipers 12U Montana Vipers 10U Montana Vipers
Select Minnesota Black Knights Team* Select One 12U Minnesota Black Knights
Select Minnesota Crusaders Team* Select One 2011/10 Minnesota Crusaders 2006 Minnesota Crusaders
Select Sabres Team* Select One 2004 Sabres 2005 Sabres 2006 Sabres 2007 Sabres 2008 Sabres 2009 Sabres 2010 Sabres 2012/11 Sabres 16U Sabres 14U Sabres 12U Sabres 10U Sabres
Select Nebraska Bugeaters Team* Select One 2006 Nebraaska Bugeaters
Select Nebraska Trail Blazers Team* Select One 2004 Nebraska Trail Blazers 2005 Nebraska Trail Blazers 2006 Nebraska Trail Blazers 2007 Nebraska Trail Blazers 2008 Nebraska Trail Blazers 2009 Nebraska Trail Blazers 2010 Nebraska Trail Blazers 2012/11 Nebraska Trail Blazers 16U Nebraska Trail Blazers 14U Nebraska Trail Blazers 12U Nebraska Trail Blazers 10U Nebraska Trail Blazers
Select Coyotes Team* Select One 2004 Coyotes 2005 Coyotes 2006 Coyotes 2007 Coyotes 2008 Coyotes 2009 Coyotes 2010 Coyotes 2012/11 Coyotes 16U Coyotes 14U Coyotes 12U Coyotes 10U Coyotes
Select North Dakota Black Knights Team* Select One 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 North Dakota Black Knights 2010 North Dakota Black Knights 2012/11 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 North Dakota Crusaders Team* Select One 2006 North Dakota Crusaders 2004 North Dakota Crusaders
Select Northland Moose Team* Select One 2004 Northland Moose 2005 Northland Moose 2006 Northland Moose 2007 Northland Moose 2008 Northland Moose 2009 Northland Moose 2010 Northland Moose 2012/11 Northland Moose 16U Northland Moose 14U Northland Moose 12U Northland Moose 10U Northland Moose
Select North Metro Wild Team* Select One 2004 North Metro Wild 2005 North Metro Wild 2006 North Metro Wild 2007 North Metro Wild 2008 North Metro Wild 2009 North Metro Wild 2010 North Metro Wild 2012/11 North Metro Wild 16U North Metro Wild 14U North Metro Wild 12U North Metro Wild 10U North Metro Wild
Select North Stars Team* Select One 2005 North Stars 2009 North Stars
Select NoDak Oilers Team* Select One 2004 NoDak Oilers 2005 NoDak Oilers 2006 NoDak Oilers 2007 NoDak Oilers 2008 NoDak Oilers 2009 NoDak Oilers 2010 NoDak Oilers 2012/11 NoDak Oilers 16U NoDak Oilers 14U NoDak Oilers 12U NoDak Oilers 10U NoDak Oilers
Select Predators Team* Select One 2004 Predators 2005 Predators 2006 Predators 2007 Predators 2008 Predators 2009 Predators 2010 Predators 2012/11 Predators 16U Predators 14U Predators 12U Predators 10U Predators
Select Red River Pike Team* Select One 2004 Red River Pike 2005 Red River Pike 2006 Red River Pike 2007 Red River Pike 2008 Red River Pike 2009 Red River Pike 2010 Red River Pike 2012/11 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 2004 Rum River Renegades 2005 Rum River Renegades 2006 Rum River Renegades 2007 Rum River Renegades 2008 Rum River Renegades 2009 Rum River Renegades 2010 Rum River Renegades 2012/11 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 2004 Solar Bears 2005 Solar Bears 2006 Solar Bears 2007 Solar Bears 2008 Solar Bears 2009 Solar Bears 2010 Solar Bears 2012/11 Solar Bears 16U Solar Bears 14U Solar Bears 12U Solar Bears 10U Solar Bears
Select Twin Cities Blast Team* Select One 2004 Twin Cities Blast 2005 Twin Cities Blast 2006 Twin Cities Blast 2007 Twin Cities Blast 2008 Twin Cities Blast 2009 Twin Cities Blast 2010 Twin Cities Blast 2012/11 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 2004 Twin Cities Vulcans 2005 Twin Cities Vulcans 2006 Twin Cities Vulcans 2007 Twin Cities Vulcans 2008 Twin Cities Vulcans 2009 Twin Cities Vulcans 2010 Twin Cities Vulcans 2012/11 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 2004 Twin Cities XTREME 2005 Twin Cities XTREME 2006 Twin Cities XTREME 2007 Twin Cities XTREME 2008 Twin Cities XTREME 2009 Twin Cities XTREME 2010 Twin Cities XTREME 2012/11 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 2004 MN Wolverines 2005 MN Wolverines 2006 MN Wolverines 2007 MN Wolverines 2008 MN Wolverines 2009 MN Wolverines 2010 MN Wolverines 2012/11 MN Wolverines 16U MN Wolverines 14U MN Wolverines 12U MN Wolverines 10U MN Wolverines
Select Wisconsin Crush Team* Select One 2004 Crush 2005 Crush 2006 Crush 2007 Crush 2008 Crush 2009 Crush 2010 Crush 2012/11 Crush 16U Crush 14U Crush 12U Crush 10U Crush
Select Chicago Wind Team* Select One 2004 Chicago Wind 2005 Chicago Wind 2006 Chicago Wind 2007 Chicago Wind 2008 Chicago Wind 2009 Chicago Wind 2010 Chicago Wind 2012/11 Chicago Wind 16U Chicago Wind 14U Chicago Wind 12U Chicago Wind 10U Chiacgo Wind
Level You're Playing At in 2019-20* Select One Mite A Mite B Mite C Squirt A Squirt B1 Squirt B2 Peewee AA Peewee A Peewee B1 Peewee B2 Bantam AA Bantam A Bantam B1 Bantam B2 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, 2020.
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, 2020.
Midsota 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, 2020.
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, 2020.
Minnesota 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, 2020.
Minnesota Crusaders 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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
Frosbite 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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
Nebraska Bugeaters 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, 2020.
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, 2020.
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, 2020.
North Dakota Crusaders 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, 2020.
Northland Moose 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, 2020.
North Metro Wild 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, 2020.
North Stars 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, 2020.
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, 2020.
Metro 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, 2020.
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, 2020.
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, 2020.
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, 2020.
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, 2020.
Total
$0.00
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