Registration Form

Come Play on our River » Registration Form

Completing the registration form now will hold your child's place in the selected week, but it can also be filled out on the first day. On the first day of the camp there will be additional forms to fill out such as a waiver form and picture release form. If you have any questions feel free to contact us at: (506)365-7787 or comeplay@nb.aibn.com

When you submit the form below, you will be asked to complete the registration process by sending in your payment or paying online (instructions are on the next page). The cost of registration is $85, we require a $40 deposit.

Come Play On Our River 2010

Participants Name:

* required

Age:

* required

Parent/Guardian Name:

* required

Address:

* required

Home Phone:

* required

Cell Number:

Email Address:

Medicare Number:

* required

Medicare Expiry Date:

* required

Sign Up Week:

* required

Emergency Contacts:

#1- Name:

* required

#1- Phone Number:

* required

#2- Name:

#2- Phone Number:

Allergies:

Other Important Medical Information: