CAPITAL AREA MINOR FOOTBALL ASSOCIATION 

215 Carriage Hill Drive

Fredericton, N.B., E3E 1A4

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     2009 SUMMER PROGRAM REGISTRATION FORM

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NAME:______________________________________ BIRTHDAY D/M/Y:  __________
ADDRESS:__________________________________  AGE ON 31/12/09:___________
                    ________________________________ HEIGHT:__________________
POSTAL CODE:______________________________ WEIGHT:__________________
PHONE:_____________________________________ OTHER  SPORTS PLAYED:
SCHOOL OR JOB:____________________________  _________________________
MEDICARE # :________________________________ _________________________
E-MAIL ADDRESS:______________________________________________________________

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PLEASE INDICATE THE AREA IN WHICH YOU LIVE (X).

LINCOLN: _____ SOUTHWOOD: _____ SKYLINE ACRES: _____
CITY CENTRE: _____ SILVERWOOD: _____ NEW MARYLAND: _____
HANWELL RD.: _____ WOODSTOCK RD.: _____ MARYSVILLE: _____
DEVON: _____ NASHWAAKSIS: _____ OROMOCTO: _____
BURTON: _____ GEARY: _____ ______________: _____

REGISTRATION

MEN'S    (SUMMER)                      $180

T-SHIRT SIZE

FEES:

WOMEN'S (SUMMER)                 $160

(CIRCLE ONE)

(CIRCLE ONE)

 

AS,   AM,  AL

 

 AXL,  AXXL

All Tackle players will also be required to make a $60 deposit on equipment at 
time of fitting by cheque dated August 15, 2009.
 Deposit cheques will be returned when equipment is returned.

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AGE CATEGORIES:

MEN'S LEAGUE PLAYERS MUST BE AT LEAST 18 ON DECEMBER 31 OF THIS YEAR.
WOMEN'S LEAGUE PLAYERS MUST BE AT LEAST 18 ON DECEMBER 31 OF THIS YEAR.

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PLAYER SIGNATURE: ___________________________ DATE: _______________

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I WOULD LIKE TO VOLUNTEER: _______ WORK PHONE NUMBER: ____________________
HAVE ANY OF THE PLAYER'S RELATIVES EVER PLAYED ORGANIZED TACKLE FOOTBALL?  _______ 

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DO YOU HAVE HEALTH INSURANCE THAT COVERS COVERS SPORTS INJURY RELATED COSTS
SUCH AS AMBULANCE, PHYSIOTHERAPY, MASSOTHERAPY, ETC.  ?       ______________
     
NOTE: PAYMENT MUST BE INCLUDED WITH THIS FORM FOR REGISTRATION TO BE PROCESSED. PLEASE DO A SEPARATE
CHEQUE FOR EACH PLAYER BEING REGISTERED.  MAKE CHEQUES PAYABLE TO CAPITAL AREA FOOTBALL.