When creating an account, please use your EMAIL ADDRESS as your USERNAME. Please enter the information for the Primary Contact (for example parent or guardian) first. You may then add additional family members by clicking on "Add Member" at the bottom of the page. Simply add the new family member and click Save at the bottom.

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M56, as amended. Inquiries about the collection of personal information should be directed to the Municipal Clerk.
First Name: *  (Primary Contact)
Last Name: *  (Primary Contact)
Middle Name:
Prefix:
Nickname:
Language:
Birthdate:
Gender:
Grade:
Address:
City:
Country:
State:
Zip:
Residency:
Phone:  (ex: XXXXXXXXXX)
Health Notes:
Emergency Contact:
Emergency Phone:  (ex: XXXXXXXXXX)
School:
Neighborhood:

Senior's Centre Membership Number::
Membership Expiry Date::

Would you like to subscribe to future email communications from the Town of Cobourg? : *

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