Current Page 1 Page 2 Preview Personal information on this form is collected under the Provincial Health Number Act R.S.P.E.I. 1988, Cap.P-27.01 and section 31 of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01, and will be used for the purpose of administering payments to the individuals or suppliers that are identified on this form. This use includes the sharing of this information within the Government of Prince Edward Island and its agencies to update and ensure accuracy of information for administering payments. Questions on the collection and use of this information can be directed to the manager of Administration at 902-368-5230. Identification Enter the parent or guardian's contact information in the fields below. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Personal Health Number (PHN) Enter the 8-digits from the PEI health card Date of Birth Do you have a spouse or common law partner? - Select -YesNo Spouse/Common Law Partner Information First Name Middle Name Last Name Personal Health Number (PHN) Enter the 8-digits from the PEI health card Date of Birth