Registering Multiple Individuals Using the Same Email Address
This form is to be completed prior to enrolling on the PORTAL by a parent/guardian/caregiver wishing to enroll more than one individual using the same email address. In order to have more than one individual enrolled using one email address, we need to create an Administrative Role in our system and link the athlete profiles manually. Once you have filled out and submitted this form, we will contact you within five (5) business days with further instructions on how to complete your Portal Enrollments.
1. Administrative Role - Contact Info
Your Name
*
First Name
Last Name
E-mail Address that will be used for the Enrollments
*
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
/
Month
/
Day
Year
Date
Which Region/Community are you participating in?
*
Central
Eastman
Interlake
Norman
Parkland
Westman
Winnipeg
If applicable, which Group Home are you affiliated with?
Name of Group Home
Mailing Address
City/Town
State / Province
Postal Code
2. Athlete / Volunteer Information
Name of Athlete / Volunteer #1
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
First Line of Address recently provided to SOM
*
e.g. 123 Anywhere Street
Relationship to Athlete / Volunteer #1
*
e.g. Caregiver, Group Home Manager
Name of Athlete / Volunteer #2
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
First Line of Address recently provided to SOM
e.g. 123 Anywhere Street
Relationship to Athlete / Volunteer #2
e.g. Caregiver, Group Home Manager
Name of Athlete / Volunteer #3
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
First Line of Address recently provided to SOM
e.g. 123 Anywhere Street
Relationship to Athlete / Volunteer #3
e.g. Caregiver, Group Home Manager
Name of Athlete / Volunteer #4
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
First Line of Address recently provided to SOM
e.g. 123 Anywhere Street
Relationship to Athlete / Volunteer #4
e.g. Caregiver, Group Home Manager
Name of Athlete / Volunteer #5
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
First Line of Address recently provided to SOM
e.g. 123 Anywhere Street
Relationship to Athlete / Volunteer #5
e.g. Caregiver, Group Home Manager
By checking the box below, you agree that you are authorized to view and edit the information of the athletes / volunteers entered above.
*
Yes, I have authorization.
SUBMIT FORM
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