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* 1. Child's Full Name:

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* 2. Age:

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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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* 16. Summer Soccer (Team/Birth Years/Cost):

*Please register your child according to their age as of January 1st, 2021.*
**A jersey deposit of $10 must be paid separately from the registration fee for U10, U12, U14, and U16-18. The deposit will be refunded upon return of the jersey at the end of the summer.**

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* 17. Summer Baseball (Team/Ages/Cost):

*Please register your child according to their age as of December 31st, 2021.
**A jersey deposit of $10 must be paid separately from the registration fee for 13U PeeWee and 15U Bantam. The deposit will be refunded upon return of the jersey at the end of the summer.**

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

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* 19. ***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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