Child Registration

To register with the Valley Recreation District, please use the following form below or download a printable version of the Child Registration Form. For payment, please make a cheque payable to Priarie View Municipality.

Registrations can be dropped off at the VRD office in Birtle (684 main st in the CDC building)

For Miniota community members registrations can be dropped off at the Municipal office in Miniota (111 Sarah Avenue)OR Emailed to recreation@myprairieview.ca

All registrations are accepted on a first come first serve basis and Full payment is required to confirm your registration.

CONTACT VRD AT 1-204-842-3460

recreation@myprarieview.ca

Child Registration Form

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		<field type="date" label="Program Date" class="form-control calendar" name="date-1681830940459"></field>
		<field type="text" subtype="text" required="true" label="Child Name" class="form-control text-input" name="text-1681830953843"></field>
		<field type="text" subtype="text" label="Child Age" class="form-control text-input" name="text-1681830969953"></field>
		<field type="date" label="Child Date of Birth" class="form-control calendar" name="date-1681830982985"></field>
		<field type="text" subtype="text" label="Child Grade" class="form-control text-input" name="text-1681830994641"></field>
		<field type="text" subtype="text" required="true" label="Parent / Guardian 1" class="form-control text-input" name="text-1681831006129"></field>
		<field type="text" subtype="text" label="Parent / Guardian 2" class="form-control text-input" name="text-1681831017122"></field>
		<field type="text" subtype="text" required="true" label="Phone (Home)" class="form-control text-input" name="text-1681831027498"></field>
		<field type="text" subtype="text" label="Phone (Work)" class="form-control text-input" name="text-1681831041385"></field>
		<field type="text" subtype="text" label="Phone (Cell)" class="form-control text-input" name="text-1681831049569"></field>
		<field type="text" subtype="text" label="Email Address" class="form-control text-input" name="text-1681831059097"></field>
		<field type="text" subtype="text" label="Mailing Address" class="form-control text-input" name="text-1681831071817"></field>
		<field type="text" subtype="text" label="Emergency Contact" class="form-control text-input" name="text-1681831079954"></field>
		<field type="text" subtype="text" label="Emergency Phone" class="form-control text-input" name="text-1681831084505"></field>
		<field type="textarea" label="Additional Information" class="form-control text-area" name="textarea-1681831108106"></field>
		<field type="checkbox" required="true" label="I certify that my child is in good health and is able to participate in vigorous activities involved with Valley Recreation District programs, and I authorize the director/instructors to seek emergency medical treatment if it is deemed necessary. This also assures that I release the instructors, Valley Recreation District, Prairie View Municipality and the program facilities from any and all liability from any injury or illness incurred going to the program from home, while at the program or returning home from the program. As well all liability for losses and damages of all and every description." class="checkbox" name="checkbox-1681831125529"></field>
		<field type="radio-group" class="radio-group" name="radio-group-1681831145409">
			<option value="I give authorization to allow pictures to be taken and used for promotion (Facebook page, posters etc.)">I give authorization to allow pictures to be taken and used for promotion (Facebook page, posters etc.)</option>
			<option value="I DO NOT give authorization to allow pictures to be taken and used for promotion." selected="true">I DO NOT give authorization to allow pictures to be taken and used for promotion.</option>
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