Waiver for Northland Hockey Group

Level*

Please select your team's age/level classification.

2015/16 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2014 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2013 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2012 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2011 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2010 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2009 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

2008 Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

10U Girls Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

12U Girls Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

14U Girls Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

16U Girls Team Name*

If your team is not listed, please contact tom@northlandhockeygroup.com

Players Name*

First Last

Jersey Number*

Birth Date*

Family's Primary Email Address*

Father's Name*

First Last

Father's Phone*

Father's Email Address*

Mother's Name*

First Last

Mother's Phone*

Mother's Email Address*

Release of Liability:*

I/We understand that Northland Hockey et al does not carry insurance on its players. I agree to save, hold harmless and indemnify Northland Hockey, its officers, coaches, instructors, support and game staff from any injury my player may sustain while a participant. I also agree to possess dental insurance as a condition of my child’s participation. I agree to allow Northland Hockey to use photos taken during tournaments and Northland Hockey events to be displayed at their discretion.

I Agree

Parent or Guardian Signature*

Waiver Form

Waiver Form

Minnesota

Iowa

Kansas City

Midwest

Nebraska

North Dakota

South Dakota

Wisconsin

Tournaments