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* 1. Child's Full Name:

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* 2. Age on December 31st, 2021:

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* 3. Birth Date:

Date

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* 4. Gender:

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* 5. Mailing Address:

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* 6. Primary Email Address:

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* 7. Secondary Email Address:

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* 8. Primary Phone Number:

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* 9. Secondary Phone Number:

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* 10. Parent/Guardian's Name:

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* 11. Other Parent/Guardian's Name:

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* 12. Family Doctor:

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* 13. Allergies or Other Medical Conditions:

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* 14. Emergency Contact #1 (Other Than Parents/Guardians):

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* 15. Emergency Contact #2 (Other Than Parents/Guardians):

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* 17. Swimming Lessons ($45 Per Session):

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* 18. Please Select the Swimming Lesson Session You Would Like to Register For:

*The Recreation Office will contact you regarding your time for swimming lessons after your registration has been processed*

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* 19. Swim Team ($50):

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* 20. Pool Passes:

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* 21. I would like to receive recreation information through E-mail from the Florenceville-Bristol Department of Recreation.

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* 22. ***PROGRAM REFUNDS will not be issued once a program starts. A $5.00 administration fee will be held for each registration refunded.***
****These programs will be following COVID-19 guidelines that are put into place by the NB Chief Medical Officer of Health****

CANCELLATION UPDATES will be on our Facebook Page: Florenceville-Bristol Recreation

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