2016 Dakota Goaltending Spring/Summer Clinic Registration 2016-17 Dakota Goaltending Fall/Winter Session Registration Player First Name * Player Last Name * Address * City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Date of Birth * Player age * Number of years played * 0123456789101112131415161718 Mom's Name * Mom's Cell Phone * Mom's Email Address * Dad's Name * Dad's Cell Phone * Dad's Email Address * Session Options * Dakota Goaltending Fall Session (Cost $200 per attendee if paid by August 30th, $250 after September 1st) Dakota Goaltending Fall & Winter Session (Cost $415 per attendee if paid by August 30th, $465.00 after September 1st ) TO PAY 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 T-Shirt Size 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 * Parent Signature * Today's Date * reCAPTCHA
