Caregiver Ongoing Training (COT) Course Registration

* Indicates Required Fields

*First Name :
*Full Middle Name (if no middle name enter none) :
*Last Name :
*Date of Birth :	/ /
*Home Address :
*City :
*State :
*Zip Code :
*Home Phone Number :	()-
Work Phone Number :	()- x
*Email Address :
If you have a disability which may require special services,
please check here :
Please check all that apply, I am a:
Foster Parent :
Adoptive Parent :
DCYF Employee :
Residential Staff :
Other :
Non-licensed Relative Care Provider :
If Foster Parent, location of District Office :
If Residential Staff, name of facility :
If Other, name of organization :
Please complete the following information for each class for which you are registering:
Course 1
Course Registration Number :
Course Title :
Course Location :
Course 2
Course Registration Number :
Course Title :
Course Location :
Course 3
Course Registration Number :
Course Title :
Course Location :
Course 4
Course Registration Number :
Course Title :
Course Location :
Course 5
Course Registration Number :
Course Title :
Course Location :
Comments :
To enroll in additional classes, please submit another registration.

Academics