Village of Carmacks - Public Access

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Step 1. Create Billing Contact

Step 2. Activate Account

Step 3. Account Activated

Contact Information Note: Red text indicates required fields.

Billing First Name:

Billing Last Name:

Address 1:

Address 2:

Address 3:

Country:

Prov/State:

Region:

City:

Postal/Zip Code:

Phone 1:

Email:

Alternate Email:

Client #:

Account Information

Username:
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Password:

Re-Type Password:

Password Strength

Note: For the best Password Strength rating include:

Uppercase and lowercase characters
Numbers
Symbols
Eight or more characters

Extra Information

Sex At Birth:

Male

Female

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Birthdate:

Guardian 1 Name:

Guardian 1 Phone:

Guardian 2 Name:

Guardian 2 Phone:

Emerg. Contact:

Emerg. #:

Permission To Take Photo(s) Granted

Medical Information

Family Doctor:

Dr. Phone:

Medical #:

List any medication presently taken:

Do you have any of the following conditions or requirements?:

Allergies:

Yes

Epi-pen Required:

Yes

Please explain:

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