COTR Kids Registration
Please complete this registration form to enroll your children in COTR Kids.

Your child(ren) will be added to one of the following programs below based on their age at registration.

COTR Nursery: Infants-3 years old. Our care team is made up of teachers who have discovered their God-given gifts through Growth Track, and parents who serve once a month as a support to this nursery program. We invite you to join our care team as a parent aid. Ask the Check-in Clerk for the form to get started!

COTR Primary: Pre-K (age 4) through 1st grade

COTR Elementary: Grades 2nd-5th


Email address *
CHILDREN INFORMATION
The info for child #1 is required. If you have more than one child you are registering, please continue onward. If you have more than four, please submit on a second registration form. Thank you.
Child #1 Registration
1a. Child's Full Name *
Your answer
1b. Gender *
1c. Date of Birth *
MM
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DD
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YYYY
1d. My child has medical concerns of which the church should be aware *
1e. Medical concerns
Your answer
Child #2 Registration
2a. Child's Full Name
Your answer
2b. Child's Gender
2c. Child's Date of Birth
MM
/
DD
/
YYYY
2d. My child has medical concerns of which the church should be aware
2e. Medical concerns
Your answer
Child #3 Registration
3a. Child's Full Name
Your answer
3b. Child's Gender
3c. Child's Date of Birth
MM
/
DD
/
YYYY
3d. My child has medical concerns of which the church should be aware
3e. Medical concerns
Your answer
Child #4 Registration
4a. Child's Full Name
Your answer
4b. Child's Gender
4c. Child's Date of Birth
MM
/
DD
/
YYYY
4d. My child has medical concerns of which the church should be aware
4e. Medical concerns
Your answer
FAMILY INFORMATION
Father/Guardian Full Name *
Your answer
Phone Number *
Your answer
Mother/Guardian Full Name *
Your answer
Phone Number *
Your answer
If the person who typically brings them to church is not the legal guardian, please list their name and relationship to child
Your answer
EMERGENCY CONTACT
Name of emergency contact *
Your answer
Best contact number *
Your answer
RELEASE AND MEDICAL AUTHORIZATION
CONSENT and CERTIFICATION I am the parent/legal guardian of the above names child(ren) and have the authority to consent to the participation of my child(ren) in COTR Kids. My children are physically fit and adequately trained to participate in such programs or events: *
Exceptions include:
Your answer
TRANSPORTATION WAIVER & CONSENT: I also consent to my children riding in a vehicle driven by a Church On The Rock pastor, staff member, volunteer, or hired commercial driver. I agree that Church On The Rock, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of COTR Kids or while traveling to and from any such program, function, or activity. I hereby waive any claims which I or my child(ren) may have or hereafter acquire against Church On The Rock, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death. *
MEDICAL AUTHORIZATION: I certify that I have the right to consent to medical treatment of the child(ren) named on this form. I do consent to any x-ray, routine tests, anesthetic, injections, medical, surgical, or dental diagnosis, treatment or hospitalization that may be deemed necessary for my child. If I cannot be reached in an emergency, I give permission to the physician selected by Church On The Rock Staff and/or its Approved Volunteers to make the decisions necessary for treatment. I agree that Church On The Rock, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death incurred by the child names on this form so long as the treatment is administered by or under the supervision of a licensed physician. Further, I am ultimately responsible for the health care cost for the above named child(ren) and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child. I understand that I am responsible for the costs of any medical care not reimbursed by health insurance. *
PHOTO USE AGREEMENT Church On The Rock has permission to use any photo in which my child is pictured for newsletters, webpages, promotions, social media, etc. *
PARENT/GUARDIAN SIGNATURE
Date Signed *
MM
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DD
/
YYYY
Printed name of Parent or Guardian *
Your answer
Parent/Guardian E-Signature *
Required
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