Director’s Home

National League of Junior Cotillions
Lubbock Chapter

Registration

Welcome to the Junior Cotillion program. The Junior Cotillion setting will encourage children to be comfortable together, make new friends, and enjoy themselves. After constant practice in a peer group, young ladies and gentlemen are expected to leave the program with the confidence and poise that comes from knowing proper etiquette in any social situation. Junior Cotillion also gives thorough training in standard ballroom dance steps using current popular music. We highly recommend that you register early, as classes are limited and are filled on a first come, first serve basis.

Registration must be approved by the Directror Kara D'Alise. Following the completion of the registration form, you will be notified by email or phone the status of your membership by March. Membership is based on equal numbers of boys to girls.

Thank you again for your interest in the Junior Cotillion and contact Kara if you have any questions. 806 773-7789 or [email protected]

2025-2026 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: 5/13/2011)

Add additional child to this registration »

2025-2026 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: 5/13/2011)

Add additional child to this registration »

2025-2026 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: 5/13/2011)

Add additional child to this registration »

2025-2026 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: 5/13/2011)

Add additional child to this registration »

2025-2026 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: 5/13/2011)

Add additional child to this registration »

2025-2026 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: 5/13/2011)

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 Lubbock 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, Kara D'Alise, 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.

As the parent/guardian, I DENY 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

Payments I'll pay with PayPal* I'll pay with Venmo I'll pay by check

*an online handling fee of 5.4% will be added to PayPal payments.

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.