2017-18 Dakota Goaltending Fall/Winter Session Registration 2017-18 Dakota Goaltending Fall/Winter Session Registration Goalies First Name * Goalies Last Name * Address * City * Dropdown * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Date of Birth * Age * 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Number of years played * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Mom's Name * Mom's Phone * Mom's Email * Dad's Name * Dad's Phone * Dad's Email * Session Options * Dakota Goaltending Fall Session (Cost $200 per attendee if paid by August 30th, $250 after September 1st) Dakota Goaltending Winter Session (Cost $250 per attendee if paid by August 30th, $300.00 after September 1st ) Both Dakota Goaltending Fall & Winter Session (Cost $415 per attendee if paid by August 30th, $465.00 after September 1st ) TO PAY YOUR REGISTRATION WITH CREDIT CARD Rental Equipment * I require rental equipment (An additional $100 fee is required for rental equipment. A separate $200 check for a security deposit is also required for all rentals) I will provide my own equipment Jersey Size * YS YM YL YXL AS AM AL AXL AXXL GC T-Shirt Size * YS YM YL YXL AS AM AL AXL AXXL Photo Release * By checking this box, I grant to Rhino Hockey, LLC the right to take photographs of my child in connection with the above-identified organization. I authorize RHLLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that RHLLC may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. Waiver * I hereby give my approval for my child's participation in the Jr. Rhino Hockey Winter Session. I assume all risks, responsibilities, and hazards incidental to such participation and so hereby waive, release, absolve, indemnify, and agree to hold harmless Rhino Hockey L.L.C and its subsidiaries, sponsors, supervisors, paticipants, coaches, referees, Scheels IcePlex, and its associates for any claims arising out of an injury to my child. Also, my signature gives permissions for my child to be admitted and attended to for medical or dental treatment in case of injury or illness. Insurance Carrier * Parents Signature * Today's Date * reCAPTCHA Submit If you are human, leave this field blank.