Register your ROTH ID TAG™

Database Registration Available Soon!

Fill out the form below to pre-register your child’s tag for the ROTH ID TAG™ Database. As soon as full registration is available you will be contacted to complete your database registration. If you have multiple children, please pre-register each of their tags individually.

Caregiver Information

Caregiver First Name*

Caregiver Last Name*

Caregiver Phone

Caregiver Email Address*

Your Relationship to Child/Children*

Child Information

Child Name

Child Date of Birth

Medical Information

Second Child Name*

Second Child Date of Birth*

Second Child Medical Info*

Third Child Name*

Third Child Date of Birth*

Third Child Medical Information*

Fourth Child Name*

Fourth Child Date of Birth*

Fourth Child Medical Information*

Fifth Child Name*

Fifth Child Date of Birth*

Fifth Child Medical Information*

Emergency Information

Identity Pin / Safe Word (Optional)

First Emergency Contact: Full Name*

First Emergency Contact: Relationship to Child*

First Emergency Contact: Cell Phone Number*

First Emergency Contact: Address*

Second Emergency Contact: Full Name*

Second Emergency Contact: Relationship to Child*

Second Emergency Contact: Cell Phone Number*

Second Emergency Contact: Address*

Third Emergency Contact: Full Name*

Third Emergency Contact: Relationship to Child*

Third Emergency Contact: Cell Phone Number*

Third Emergency Contact: Address*

Create a Password

Password*

Confirm Password*

Only fill in if you are not human

Register your ROTH ID TAG™

Database Registration Available Soon!

First Responder Approved

Patent-Pending Design

Made in the United States

Family Owned
& Operated

Portion of All Proceeds Donated

Register your ROTH ID TAG™

Database Registration Available Soon!

First Responder Approved

Patent-Pending Design

Made in the United States

Family Owned & Operated

Portion of All Proceeds Donated

Family Owned
& Operated