Director’s Home

National League of Junior Cotillions
Roanoke Valley Chapter

Registration

A hearty welcome to our new families, and welcome back to our returning families!

Dates and times for the upcoming 2024-2025 season of cotillion classes and dances are still being finalized.

Tuition for the 2024-2025 Cotillion is $400.

New families will register for "Season One: New Students" and returning families will register for "Season Two: Returning Students"

If your student is in high school now and would like to help as an assistant, that would be amazing just let me know! Thanks! Jessica Hilbish

New families! Please save the GPS address for the Shenandoah Club: 31 Bullitt Ave., SW Roanoke, VA 24011. There is a parking lot there for members and guests, please feel free to use it on the evenings we meet.

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, Jessica Hilbish, with those details.

Please grant permission to the Junior Cotillion, Roanoke Valley to use photos and videos taken at Junior Cotillion for use in newsletters, publicity, and web content. The National League of Junior Cotillions will not use names or identifying information about students.

The mailing address for Cotillion is

PO BOX 8194

ROANOKE, VA 24014

2024-2025 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 »

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 Roanoke Valley 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, Jessica Hilbish, 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 by check

*an online handling fee of 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.

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Director’s Home

National League of Junior Cotillions
Roanoke Valley Chapter

Registration

2024-2025 Student Information

2024-2025 Student #2 Information

2024-2025 Student #3 Information

2024-2025 Student #4 Information

2024-2025 Student #5 Information

2024-2025 Student #6 Information

About the Parents

Younger Siblings