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Waiver Form
Waiver Form
Level
*
Please select your team's age/level classification.
Select age/level classification
2015/16
2014
2013
2012
2011
2010
2009
2008
10U (Girls)
12U (Girls)
14U (Girls)
16U (Girls)
2015/16 Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
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Blue Mound Bison
Fargo Grinders Black
Fargo Grinders Green
Ice Clams
Jr. Flomingo's
Jr. Sioux 2015
Minnesota Knights
Roosters
St. Cloud Grizzly's
Skeeters
SD Selects 2015/16
2014 Team Name
*
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Blue Mound Bison
Fargo Grinders Black
Ice Clams Black
Ice Clams Gray
Jr. Flomingo's
Midwest Warriors
Northeast Elite
Pokegama Factory
Roosters
St. Cloud Grizzly's
Skeeters
SD River Kings Black
SD River Kings Gold
Spiders Hockey Club
2013 Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
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Blue Hills Beasts
Blue Mound Bison
Ice Clams Black
Ice Clams Gray
Jr. Flomingo's
Marshall Hornets
Midwest Warriors
Minnesota Knights
Minnesota Twisters
Nodak Knights
St. Cloud Grizzly's
Skeeters
SD Selects 2013
2012 Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
Select your team
Blue Mound Bison
Fargo Grinders Green
Ice Clams
Marshall Hornets
Minnesota Knights
Pokegama Factory
Roosters
St. Cloud Grizzly's
SD River Kings
Spiders Hockey Club
2011 Team Name
*
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2010 Team Name
*
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Select your team
2009 Team Name
*
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2008 Team Name
*
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10U Girls Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
Select your team
12U Girls Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
Select your team
14U Girls Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
Select your team
16U Girls Team Name
*
If your team is not listed, please contact tom@northlandhockeygroup.com
Select your team
Players Name
*
First
Last
Jersey Number
*
Birth Date
*
Month
Day
Year
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
*
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