13437 10/2021
New Brunswick Travel Registration Program
TRAVELLER INFORMATION
Last name: First name: DOB:
YYYY / MM / DD
Full Civic Home Address:
Email address:
Main Phone Number: Secondary Phone Number:
Preferred Language:
English French I am a NB Resident: Yes No
DEPENDANT TRAVELLERS (IF APPLICABLE)
Please list any dependant travellers, who are not eligible to be vaccinated due to age:
Name DOB:
YYYY/MM/DD
Name DOB: YYYY/MM/DD
Name DOB: YYYY/MM/DD
Name DOB: YYYY/MM/DD
Name DOB: YYYY/MM/DD
Name DOB: YYYY/MM/DD
VACCINATION STATUS
Fully vaccinated means having received the full series of a Health Canada approved vaccination (both doses of a 2 dose
vaccine or the only dose of a single dose vaccine)
Are you fully vaccinated?
Yes No Date of latest dose (if applicable): YYYY/MM/DD
Do you have a valid medical exemption for the COVID-19 vaccine signed by a health care professional? Yes No
DETAILS OF PLANNED TRAVEL
Planned Date of Entry to NB: YYYY/MM/DD
(arrival date for Non-Residents and return date for NB Residents)
Full civic address of where you are going:
Full civic address of where you are coming from:
Border Entry Location:
NEXT STEPS
• Fill out this form
• Then attach with your proof of vaccination, if you are fully vaccinated or your proof of valid medical exemption, if you are
medically exempt
• Email it to border.frontiere@gnb.ca
You will then receive an email confirmation to the email address from which you’ve sent your registration form
providing you with instructions to direct you whether self-isolation is required or not.
