RDCK Recreation Client Profile Form

Information Collection Statement

Personal information and records you provide in this form is collected pursuant to section 26 of the Freedom of Information and Protection of Privacy Act.

This information will be used for the purpose of creating/updating your Perfect Mind account profile in the Regional District of Central Kootenay Recreation.

Questions about the collection of this information may be directed to the Privacy Officer, 250-352-6665, info@rdck.bc.ca or Box 590, 202 Lakeside Drive, Nelson, BC V1L 5R4.

Main Contact Name (as it will appear in RDCK Recreation Profile)*

First NameLast Name

Gender*

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Would you like to add any family members?

YesNo

Additional Family Members (same household only)*

Profile Photo Upload

Profile photos are only used to create/update client accounts. Acceptable photos must be:

clear, sharp and in focus
taken with eyes open and clearly visible
taken without shadows, glare or flash reflections
taken straight on with face and shoulders centered and squared to the camera
taken in front of a neutral background
not taken from an existing photo
taken within 12 months to reflect your current appearance

Main Contact Profile Photo Upload

Additional Family Member(s) Photo Upload - filename(s) must include family member's name

Preferred Recreation Facility*

Castlegar & District Community ComplexCreston & District Community ComplexNelson & District Community ComplexSalmo & District Recreation Deparment

Background Information

Various Recreation services and programs require proof of vaccination before participating in accordance with recent Provincial and Medical Health Orders. The RDCK is offering solutions to make this process more convenient without having to show proof of vaccination every time you visit.

Providing proof of vaccination using this form is completely optional, but offers the opportunity to users of RDCK recreation facilities to bypass vaccine status checks each visit.

If you prefer to provide proof of vaccination in person, you can visit your nearest recreation facility to provide your consent with proof of vaccination to allow RDCK to keep your vaccination status on file.

All proof of vaccination submissions will require a photo kept on file to verify your identity each visit. If you do not already have a photo on file in our Perfect Mind system (all previous pass holders will have had one), you will be asked to have your picture taken at your next visit.

Once vaccination requirements are no longer in effect in BC, all personal vaccination status records that were provided will be deleted.

I would like to submit my vaccine status information on this form.*

YesNo

Records Upload

Proof of Vaccination (QR Code Image or scanned document of out-of-province immunization record) - you can upload more than one file (for multiple family members)*

Proof of Valid Government Photo Identification - AGES 19+ ONLY (ie. BC Driver's License or BC Services Card, Passport, or photo ID issued by another province or territory) - you can upload more than one file (for multiple family members)*

Consent

I agree and consent to the Regional District of Central Kootenay (RDCK) collecting and storing my Covid-19 vaccine status in my Perfect Mind account.

The RDCK is collecting this information for the sole purpose of confirming my proof of vaccination to allow me to attend and participate in a recreational activity offered by the RDCK that requires proof of a Covid-19 vaccination (Activity). This information will not be shared with anyone and will be deleted by the RDCK when it is no longer required.

I confirm that I can withdraw this consent at any time by contacting my nearest recreational facility and informing you that my consent is withdrawn.

I further acknowledge that I may be asked to produce my proof of vaccine card and valid government identification before participating in an Activity, and that I will comply.

If I have any questions about this consent, I will contact my nearest recreation facility.

Castlegar & District Community Complex (250)365-3386
Creston & District Community Complex (250) 428-7127
Nelson & District Community Complex (250) 354-4386
For all Salmo inquiries, please contact Nelson & District Community Complex