Online Registration Name First Last Date of Birth 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 Home PhoneWork PhoneEmergency Contact NameEmergency Contact PhoneDoctorDoctor's PhoneNB 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 9:00-10:00 a.m. A1: Tuesday & Thursday 4:45-6:00 p.m. A2: Tuesday & Thursday 4:45-6:00 p.m. AA: Mon,Fri 4:00-6:00 p.m. & Wed 3:45-6:00 p.m. AAA: Mon, Tue, Thu, Fri 4:00-6:00 p.m. & Wed 3:45-6:00 p.m. Summer Program: Kinsmen Outdoor Pool Mon-Wed-Fri 4pm – 5pm Summer Program: Chatham Outdoor Pool Mon-Wed-Fri 11am-12 noon Date of application 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.