RDCK Recreation Client Profile Form

RDCK Recreation Client Profile Form

Account Creation
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.
Client/Family Profile

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

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
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

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Additional Family Member Profile Photo Upload

File name must include additional family members name in the file name.
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Preferred Recreation Facility*

Castlegar & District Community ComplexCreston & District Community ComplexNelson & District Community ComplexSalmo & District Recreation Deparment
Records Upload
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)*

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RDCK Recreation Client Profile Form

Client/Family Profile

RDCK Recreation Client Profile Form