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North Little Rock Junior Cotillion
About
Programs
Enrollment Information
Class I
Class II
Class III
REGISTER ONLINE
Printable Form
COMPLETE this digital registration form AND
pay online using the links below in order to complete registration
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Indicates required field
Student's Preferred Name
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First
Last
Student:
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Male
Female
Select school grade for FALL 2023
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5th grade (Cotillion Club)
6th grade (Class 1)
7th grade (Class 2)
8th grade (Class 3)
School attending--FALL 2023
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Student's Date of Birth
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List siblings also enrolled in NLRJC programs:
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Is there any special information we should know about your student (ex. allergens)?
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Permission is hereby granted to use any photograph or video likeness of the student from the cotillion program in any manner, without obtaining subsequent permission or consent and without payment of further consideration. I agree to defend, indemnify, and hold Junior Cotillion of North Little Rock, LLC harmless from and against any claim, demand, or cause of action that I may make because of the use of any such photograph or likeness in any manner. I understand that photograph WILL NOT have the student identified by name except in the listing of the Holiday Ball and Spring Finale awardees. Images of this student may be used in print or electronic media coverage
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YES, Image may be used
NO, Image may NOT be used
Student's Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
Primary Parent Name, Email, and Phone Number
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2nd Parent's Name, Email, and Phone Number
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Emergency Contact NAME, RELATIONSHIP, PHONE NUMBER
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I agree to receiving marketing and promotional materials
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Submit
Tuition Policy: Tuition Payments are NON-REFUNDABLE
Cotillion Club (5th grade)
$139.00
Pay Tuition
6th Grade Registration
$209.00
Pay Tuition
7th Grade Registration
$209.00
Pay Tuition
8th Grade Registration
$139.00
Pay Tuition