Director’s Home

National League of Junior Cotillions
Texarkana Chapter

Registration

We are honored to have your child particpate in our next season for Junior Cotillion!

HOW TO ENROLL YOUR CHILD

Choose the registration tab below and follow the simple prompts

Complete the registration form online

Choose method of payment and amount

More Details

You will receive an email confirmation of your registration. You may pay the full tuition or you may pay half with registration and the balance is due no later than September 1.

To pay online, you may use credit or debit card through PayPal – there is a fee to use PayPal. If you make a partial payment, you will be sent a link for your second payment in August. You may also make your second payment at any time before September 1 by contacting the director for the link .

To pay by mail, make your check payable to Melissa W. Delk, please put your child’s first and last name with the letters NLJC in the memo line, mail to NLJC-Texarkana C/O Melissa Delk 440 Deer Creek Lane Texarkana, TX 75501. If you make a partial payment, you will receive a reminder of second payment in the mail and email in August. You may also make your second payment at any time before September 1.

Read the class descriptions under classes tab at left to choose the correct registration tab You will need to choose your class at the drop down at top of registration form.

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 »

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 Texarkana 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, Melissa Delk, 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 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.

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Director’s Home

National League of Junior Cotillions
Texarkana Chapter

Registration

We are honored to have your child particpate in our next season for Junior Cotillion!

HOW TO ENROLL YOUR CHILD

2025-2026 Student Information

2025-2026 Student #2 Information

2025-2026 Student #3 Information

2025-2026 Student #4 Information

2025-2026 Student #5 Information

2025-2026 Student #6 Information

About the Parents

Younger Siblings