North Dakota Blackhawks
“AAA” Hockey Club
2015 Player Registration
Participant’s
Name
Address
City
DOB
State
Zip
Cell Phone # (If player has one)
Position
Mother
Father
Cell Phone
Cell Phone
E-mail
E-mail
2014 Winter
Team
2014 Winter
Level
Participants are required to have their own primary medical coverage to participate with the North Dakota
Blackhawks.
Waiver and Release of Liability/Acknowledgement or Risk
I/We understand that the North Dakota Blackhawks AAA Hockey Summer Club does not affiliate with USA Hockey
and is therefore not underneath the personal injury insurance of USA Hockey. To be considered for participation
with the N.D. Blackhawks in 2015, I/We acknowledge, appreciate, and agree to:
 Hold Harmless and indemnify the N.D. Blackhawks AAA Summer Hockey Club, and its directors, from any
injury my player may sustain while a participant. We agree that the ND Blackhawks will not be held
responsible for any injury that may be sustained as a result from participating with the ND Blackhawks.
 I knowingly and freely assume all risks associated with participation, and assume full responsibility for my
child while participating in 2015 with the N.D. Blackhawks AAA Hockey Program.
 I have read this release of liability. I understand the terms, and that I have given up rights by signing this
waiver/release.
Father Signature
Mother Signature
The N. D. Blackhawks would like to thank you for your interest in participating with the North Dakota Blackhawks
in 2015. By registering to participate, you assume all risks associated with the game of hockey, as well as all fees
that are due for participating. A minimum deposit of $100.00 is due with this registration form. Team fees will be
paid in full at first team tournament, unless arragements are made. Team fees vary by level based on tournament
being attended. If tryouts are held for any particular level, and a player does not make a team, refunds will be
given to players.
Submit completed registration form, and player deposit to:
N.D. Blackhawks Hockey
Contact:
4535 Sunset Boulevard
Ryan Griggs
West Fargo, ND 58078
ryangriggs@ndblackhawks.com