Create Account

> Home Page > Create Account

If you are a current WC member who visits the WC, you have an account due to your membership. Please contact the WC at 208-686-9355 Ext. 500 or email jizaguirre@marimnhealth.org (or Text 208-964-6729) to receive your login name and temporary password. If you create a new account, you'll have a duplicate membership on file and will not have accurate information regarding your current membership or be able to manage your current membership online. If you are planning on joining the Wellness Center, planning to enroll in a sport league or other WC Event as a Non-Member, then please sign up for a new account.

Name & Address

Please note that in order to create an account for a child you must create an account for an adult first. Additional family members can be added to your account during registration.

* Denotes a required field.

First Name

Middle Name

Last Name

Street Address

City, State, Zip Code

Add Mailing Address(if different from above)

Mailing Address

City, State, Zip Code

Contact Information

Please enter your best contact information.

* Denotes a required field.

Primary Phone

Extension

Secondary Phone

Extension

Text Alert Phone

Text Alert Carrier

Yes, I agree to receive text messages

Email address

Additional email address

Yes! Please email me the latest news and information.

Yes! Please mail me the latest news and information.

Personal Information

Please enter your personal information.

* Denotes a required field.

Role in Family

Gender

Date of Birth

or Age Category

Head of Household

Customer Type

Occupation

Medical Alert

Questions

Please describe any special needs we need to be aware of. (Drug or Food Allergies, Current Medications, Any Current Health Problems such as asthma or diabetes)

Would you like to learn more about Volunteer opportunities here at Marimn Health Wellness Center?

Emergency Contact

Please enter your emergency contact(s).
* Denotes a required field.

First Name

Last Name

Relationship

Primary Phone

Extension

Other Phone

Extension

Add another Emergency Contact

First Name

Last Name

Relationship

Primary Phone

Extension

Other Phone

Extension

Account Information

Please enter your account information.

* Denotes a required field.

Email address

Add Alternate Login ID

Alternate Login ID

Password

Contain at least eight characters in length

Contain at least one letter and one number

Confirm Password

Security Question

Specify Your Question

Answer

Confirm Answer

By creating an account, you are agreeing to terms of use and privacy rights.

Marimn Health Medical Wellness Center (P&R):
Terms of Use | Your Privacy Rights

Active Network, LLC:
Terms of Use | Copyright Policy | Your Privacy Rights

Failed to finish loading this page. Please refresh this page and try again.

Please verify that you are not a robot.

Create AccountCreate Account and Add Family Member