Registration

Player Name*

Address*

Street Address Address Line 2 City Province Postal Code

Home Phone

Work Phone

Cell Phone

Player DOB*

YYYY

MM

DD

Medicare #*

Other Insurance

Email*

Parent / Guardian*

SNB#*

SNB#

Player Level (please check one)*

Number of Players*

If you have a second or additional children registering additional boxes will appear after you choose the number of players.

Player 2 Name*

Player 2 Medicare #*

Player Two DOB*

YYYY

MM

DD

SNB# Player 2*

SNB# Player 2

Player 2 Level (please check one)*

Player 3 Name*

Player 3 Medicare #*

Player 3 DOB*

YYYY

MM

DD

SNB# Player 3*

SNB# Player 3

Player 3 Level (please check one)*

Learn to Play - One Child Only -Born 2015 or later
U11 – Born 2013 - 2014
U13 – Born 2011 - 2012
U15 – Born 2010 - 2009
U17 – Born 2008 - 2007
U19 – Born 2005 - 2006
Born 2004 and earlierSenior – Born 2004 and earlier

Player 4 Name*

Player 4 DOB*

YYYY

MM

DD

Player 4 Medicare #*

SNB# Player 4*

SNB# Player 4

Player 4 Level (please check one)*

T-Shirt Size - Learn to Play

Waiver (Please Read and Check)*

Checking this box confirms my agreement to the form waiver

I hearby waive and release the Greater Moncton Royal Softball Association, its agents, representatives, coaches, officials, directors, and sponsors from any claim or actions from any injury which might be received by my child(ren) during either Association activities. I certify the above mentioned date of birth(s) is correct and am willing to provide proof if necessary.

ATHLETE MEDIA RELEASE FORM (Please Read and Check)*

Checking this box confirms my agreement to the ATHLETE MEDIA RELEASE FORM waiver

I do hereby agree and give consent for Moncton Fastpitch Association and/or its representatives to record, film, photograph, audiotape or videotape my child (children), name, image for promotional purposes of any kind, website, brochures, social media platform - including, but not limited to Facebook, Instagram, SnapChat, website, Youtube, broadcasting, newspaper.

Volunteer Information A SUCCESSFUL ORGANIZATION NEEDS YOUR HELP

Volunteer Name

Volunteer Telephone

Volunteer Email

Volunteer Activities

Coach
Asst. Coach
Umpire
Tournament Help
Other

Interested in playing Provincial Softball for the 2024 season*

No
Yes

2024 season *Additional fees are associated with this registration. Cost will be $50 per player.

Total

CAD$ 0.00 CAD

Not to exceed $400 per family for membership portion.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

IMPORTANT

Online Registration

Email Us:

****IMPORTANT****

Online Registration

IMPORTANT