Accounts are required for registration for any programs or services offered by Extreme Ice Center.

Parents, please put YOUR INFORMATION in this first form, not your child's. The first section of this page is for the Primary Account information.


First Name: *  (Primary Contact)
Last Name: *  (Primary Contact)
Middle Name:
Nickname:
Language:
Birthdate: *
Gender: *
Address: *
City: *
Country: *
State: *
Zip: *
Phone: *  (ex: XXXXXXXXXX)
Health Notes:
Emergency Contact: *
Emergency Phone: *  (ex: XXXXXXXXXX)

Customer Since?: *
Are you an Indian Trail Resident?: *

     
Email: *
Password: *  
Verify Password: *  
Password Requirements: Between 8-16 characters, 1 alphabetic, 1 numeric, 1 special character (!@#^*-=), no spaces
Family Members: