Transportation & Environment Services

2017 Playground Program Registration

indicates a required field









(If registering more than one child, please complete a second form.)







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dd/mm/yyyy




Indicate any allergies, medical issues or other information about your child. Please note that while we aim to be an inclusive program, children must be able to self-care (bathroom) and able to be supervised and participate within a group setting. (256 characters left)


With whom child resides at least 50% of the time.




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(if applicable)


(mother, father, step-parent, grandparent or other guardian)


(if different from Primary Parent/Guardian)


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This person is a parent, grandparent, guardian or sitter who is responsible for daily care of the child. They are available to immediately retrieve child as required.



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By checking this box, you understand and acknowledge that all participants of the Playground Program require a responsible guardian for their daily care who is immediately available to retrieve child from program as required.

I have read and agree to the terms and conditions outlined in the City of Saint John Release Agreement. I understand I must sign the Release Agreement on Day 1 of my child participating in the Program.

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