National League of Junior Cotillions
Southlake Chapter

Registration

Tuition:

Junior Cotillion Year I - $475
Junior Cotillion Year II - $525

There are two payment options for Junior Cotillion. Either paid in full at the time of registration or $250 may be paid at the time of registration, with the balance due by August 1, 2026. Refunds for Junior Cotillion will not be issued after June 30, 2026.

Payments:

Payments can be made through Stripe at the time of registration:

Thank you for your interest in the NLJC program. Please feel free to contact me with any questions. Contact Ashley Duckett at [email protected] or 760-954-1215.

Please encourage your fellow friends, family and community members in grades 6-8 to participate in cotillion with you.

2026-2027 Student Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

Add additional child to this registration »

2026-2027 Student #2 Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

Add additional child to this registration »

2026-2027 Student #3 Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

Add additional child to this registration »

2026-2027 Student #4 Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

Add additional child to this registration »

2026-2027 Student #5 Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

Add additional child to this registration »

2026-2027 Student #6 Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 05/13/2011)

About the Parents

How did you hear about us? *

Parent / Guardian 1 Salutation

Parent / Guardian 1 First Name *

Parent / Guardian 1 Last Name *

Parent / Guardian 1 Email Address *

Parent / Guardian 1 Email Address (Again)*

Parent / Guardian 1 Cell (or Preferred) Phone *

Parent / Guardian 1 Occupation

Parent / Guardian 2 Salutation

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Parent / Guardian 2 Email Address

Parent / Guardian 2 Cell (or Preferred) Phone

Parent / Guardian 2 Occupation

Photo and Video Release*

Please use the checkbox below to grant permission to the National League of Junior Cotillions and National League of Junior Cotillions Southlake Chapter to use photos and/or videos taken at NLJC events for any legal use, including but not limited to newsletters, publicity, and web content, UNLESS I notify the director, Ashley Duckett, in writing (with instructions and a photo of the child) before classes begin. The National League of Junior Cotillions will not use names or identifying information about students in any publication.

As the parent/guardian, I GIVE permission for images of my child(ren) to be used by The National League of Junior Cotillions in print or electronic materials as indicated above.

Allergies * I understand the director will not be held responsible with respect to accommodating food-born allergies.

Note to Director

Payment Method*

I'll pay by Credit or Debit Card

I'll pay by Bank Transfer (ACH)

* A 3% processing fee applies to credit and debit card payments. A 0.8% processing fee applies to ACH bank transfers.

Payment Terms*

One-time payment

Deposit now, remainder later

Younger Siblings

We attempt to ensure that younger siblings receive an invitation to participate, once they have reached the appropriate age for cotillion classes. If interested, please provide some information about younger siblings.

Sibling 1 First Name

Sibling 1 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 2 First Name

Sibling 2 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 3 First Name

Sibling 3 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 4 First Name

Sibling 4 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Please note: If your child has any special dietary restrictions or any conditions that would restrict their ability to participate in cotillion activities, please contact the director with those details.

Director’s Home

National League of Junior Cotillions Southlake Chapter

Registration

2026-2027 Student Information

2026-2027 Student #2 Information

2026-2027 Student #3 Information

2026-2027 Student #4 Information

2026-2027 Student #5 Information

2026-2027 Student #6 Information

About the Parents

Younger Siblings

National League of Junior Cotillions
Southlake Chapter