2019 Dakota Goaltending Spring Registration 2019 DAKOTA GOALTENDING SPRING REGISTRATION Players First Name * Last Name * Address * City * State * 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 * DOB * Players Age * 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Years Played Goalie * 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 * Dakota Goaltending Spring Session (Cost $250.00 per goalie if paid by March 25th 2019, after March 25th $275.00) PAY WITH CREDIT CARD Goalie Gear Rental I HAVE MY OWN GOALIE GEAR I NEED TO RENT GOALIE GEAR Goalie Gear Rental Form Jersey Size * YS YM YL YXL AS AM AL AXL AXXL GC T-Shirt Size * YS YM YL YXL AS AM AL AXL AXXL Waiver * I assume all risks and hazards incidental to such participation and do hereby waive, release, absolve, indemnify, and agree to hold harmless Rhino Hockey L.L.C., the organization, sponsors, supervisors, participants, coaches, captains, officials, and its associates for any claim arising out of an injury of accident Option 2 Photo Release * By checking this box, I grant to Rhino Hockey, LLC the right to take photographs of me 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 me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. By checking this box, I DO NOT grant to Rhino Hockey, LLC the right to take photographs of me in connection with the above-identified organization. INSURANCE * Parents or Guardian Signature * DATE * reCAPTCHA Submit If you are human, leave this field blank.