CLASSIC COTILLION, LLC

Email Address *

Please use an email that you check at least once a week. However, avoid using a Comporium account because Comporium blocks MailChimp emails.

Alternate Email Address (for Comporium Users)

If you use Comporium, please provide another email.

Participant's First Name *

Participant's Preferred Name *

This name will be used for student name tags and work book labels.

Participant's Last Name *

Participant's Gender *

Lady
Gentleman

Participant's Grade *

Please indicate which grade your child will begin in August 2019.

Participant's School *

Please indicate which school your child will attend.

Class Location Selection *

Gaston County (NC)
Lancaster County (SC)
York County (SC)

Please select the location that your child will attend.

Home Telephone Number *

( ) -

If you do not have a home phone, please use (555) 555-5555.

Mailing Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

All Classic Cotillion correspondence will be mailed to this address.

Father's Title *

This title will be used when addressing envelopes.

Father's First Name *

Father's Last Name *

Father's Contact Number *

( ) -

Please include either a cell number or a work telephone number. If you do not wish to include one, use (555) 555-5555.

Mother's Title *

This title will be used when addressing envelopes.

Mother's First Name *

Mother's Last Name *

Mother's Contact Number *

( ) -

Please include either a cell number or a work telephone number. If you do not wish to include one, use (555) 555-5555.

Please mail all correspondence to: *

Family Dynamic (Click for more information) *

If you think it is important for us to know, please list any special circumstances (grandparents as guardians, a deceased parent, blended family, etc).

Sibling Information *

Please list the first/last names of all siblings, their genders, and grades they will enter in August 2019. Please type "none" if there are no siblings.

Participant's Birthday *

Month / Day

Please enter your child's 2 digit month and 2 digit day.

Participant's Allergies *

Please list any known allergies.

How did you learn about us? *

Please nominate one friend. *

Include the child's first/last name, gender, grade in August, and parent's email or mailing address.

Photo Release (Click for more information) *

Yes, I consent to the Photography Permission Release.

Please read: http://www.classiccotillion.com/media-release.html

Next Steps... *

Please send me an invoice so that I can reserve my spot today.
Please send me an invitation for membership so that I can learn more about this excellent program.

Let CLASSIC COTILLION know what action you are ready to take. Remember that we ONLY reserve a spot for students who pay a deposit.

CLASSIC COTILLION, LLC 2019-2020 Gold Students

CLASSIC COTILLION, LLC
2019-2020 Gold Students