FOOTBALL NEW BRUNSWICK
34 Upton Street |
Moncton, N.B., E1E 3Z! |
2005 19 & UNDER ELITE PROGRAM WEBSITE REGISTRATION FORM
| NAME:_______________________________ | BIRTHDAY D/M/Y: __________ |
| ADDRESS:___________________________ | AGE ON 31/12/05:___________ |
| ____________________________ | HEIGHT:__________________ |
| POSTAL CODE:_______________________ | WEIGHT:__________________ |
| PHONE:______________________________ | PREVIOUS FOOTBALL EXPERIENCE: |
| SCHOOL (SEPT./05):___________________ | _________________________ |
| MEDICARE # :_________________________ | _________________________ |
| E-MAIL ADDRESS:_____________________ |
| First Choice | Second Choice | |
| Positions: Offense | ||
| Positions: Defense |
| Health or Medical Conditions: Details Please- |
NON- REFUNDABLE TRYOUT FEE: 19 & UNDER TEAM TRYOUT FEE $100 |
T-SHIRT SIZE |
|
REGISTRATION FEES: |
March 15- $TBA | (CIRCLE ONE) |
(Refunded to players cut) |
April 15- $TBA | AS, AM, AL |
| June 1- $TBA | AXL, AXXL |
|
|
AGE CATEGORIES: |
| 19 & UNDER TEAM PLAYERS CANNOT TURN 19 IN THE YEAR OF PLAY. |
| PARENT /GUARDIAN SIGNATURE: ________________________ DATE: ___________ |
| I WOULD LIKE TO VOLUNTEER: _______ WORK PHONE NUMBER: _________________ |