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Name & Address

Please enter in the main contact's name and address first.

The main contact refers to the primary adult on the account. Anyone under the age of 18 should not be the main contact.

Additional adult and children family members can be added once the main account has been created.

*Denotes a required field.

First Name

Last Name

Street Address

City, Province, Postal Code

Add Mailing Address(if different from above)

Mailing Address

City, Province, Postal Code

Contact Information

Please enter in the main contact's phone number and email address. The information entered here should be where the main contact is best reachable in time-sensitive situations.

For child family members, please leave the email address field blank.

*Denotes a required field.

Primary Phone

Extension

Secondary Phone

Extension

Cell Phone

Cell Carrier

Yes, I agree to receive text messages

Email address

Yes! Please email me the latest news and information.

Personal Information

Please enter in gender, date of birth, and any relevant medical or special needs information.

*Denotes a required field.

Gender

Users must be 13 years of age or older.

Date of Birth

or Age Category

Main Account Contact

Customer Type

Medical Alert

Questions

Emergency Contact

Please enter in an emergency contact. this contact should be someone who Place des Arts can call in the event of an emergency, and the main account holder can not be reached.

*Denotes a required field.

First Name

Last Name

Relationship

Primary Phone

Extension

Other Phone

Extension

Add another Emergency Contact

First Name

Last Name

Relationship

Primary Phone

Extension

Other Phone

Extension

Account Information

Please enter a password for your account.

*Denotes a required field.

Email address

Add Alternate Login ID

Password

Contain at least eight characters in length

Contain at least one letter and one number

Confirm Password

By creating an account, you are agreeing to terms of use and privacy rights.

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