Online Registration Name First Name Last Name Date of Birth (YYYY/MM/DD) Date Format: YYYY slash MM slash DD Age as of December 31stParents/GuardiansAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email Address Home Phone #Father's Cell #Mother's Cell #DoctorDoctor's Phone #NB Medicare #Expiry Date*Does the participant have any pre-existing medical conditions that the coaching staff should know about?Miramichi Whitecaps SwimmingChoose one of the following groupsChoose one of the following groups Beginner - **Saturday 9:00-10:00AM** Group A - **Tuesday & Thursday 4:45-6:00PM** Group AA - **Monday & Friday 4:00-6:00PM, Wednesday 3:45-6:00PM** Group AAA - **Monday, Tuesday, Thursday and Friday 4:00-6:00PM, Wednesday 3:45-6:00PM** Masters - **Wednesday 5:00-6:00PM, Saturday 8:00-9:00AM** Date of application Date Format: MM slash DD slash YYYY Printable Version If you prefer to mail in your registration form, please download and print our pdf form. Contact Us If you have any questions, would like to become a member or a volunteer you can email us at email@example.com or fill out the form on the right. We train at Miramichi Valley High School 345 McKenna Ave Miramichi, NB E1V 3S9 Name Please enter your name. Email Please enter a valid email. Your Message Please enter a message. Send Message Sent! Message failed. Please try again.