Waiver for Northland Hockey Group

Level*

Please select your team's age/level classification.

2014/15 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

2007 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

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 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 player may sustain while a participant. I also agree to possess dental insurance as a condition of my child’s participation.

In addition, the undersigned hereby acknowledges that the novel coronavirus (COVID-19) infections have been confirmed throughout the United States. The undersigned agrees that no participant or family member will visit or utilize the tournament facilities or programs if he or she experiences symptoms of COVID-19 and will not visit or utilize the tournament facilities or programs for 14 days after any exposure to any person who has a suspected or confirmed case of COVID-19.

I agree to allow Northland Hockey Group, LLC to use photos taken during tournaments and Northland Hockey Group, LLC events to be displayed at their discretion.

I Agree

Parent or Guardian Signature*

Waiver Form

Waiver Form

Minnesota

Iowa

Midwest

Nebraska

North Dakota

South Dakota

Wisconsin

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