Online Registration

Name
First Name Last Name
Date of Birth (YYYY/MM/DD)
YYYY slash MM slash DD
Age as of December 31st
Parents/Guardians
Address
Street Address Address Line 2 City Province Postal Code
Email Address
Home Phone #
Father's Cell #
Mother's Cell #
Doctor
Doctor's Phone #
NB Medicare #
Expiry Date
*Does the participant have any pre-existing medical conditions that the coaching staff should know about?
Miramichi Whitecaps Swimming
Choose one of the following groups
Choose one of the following groups
- Beginner - **Saturday 8:00-9:00AM and 9:00-10:00AM**
- Group A1 - **Tuesday & Thursday 4:00-5:00PM, Saturday 8:00-9:00AM**
- Group A2 - **Tuesday & Thursday 5:00-6:00PM, Saturday 9:00-10:00AM**
- Group AA - **Monday-Friday 4:00-5:30PM**
- Group AAA - **Monday-Friday 4:00-6:00PM, Saturday 8:00-10:00AM**
I allow my child to be photographed during competitions, training and other activities related to the Miramichi Whitecaps. These photos can be used for archive souvenirs or promotional activities for the Miramichi Whitecaps (eg. newspaper articles, business promotions and web pages for club). Pictures may also be used on social media sites, like our Facebook page, Instagram and Twitter.
- Yes
- No
I have received the "Letter to Swimmer" from SwimmingNB.*
- Yes
- No
Attachment: Letter to Swimmer
Date of application
MM slash DD slash YYYY
CAPTCHA

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 whitecapswimming@gmail.com or fill out the form on the right.

We train at Miramichi Valley High School
345 McKenna Ave
Miramichi, NB E1V 3S9

Online Registration

Miramichi Whitecaps Swimming

Contact Us