Cotillion Enrollment Form
To enroll your child, please print and fill out this form and mail it to:
The Cotillion
25-13 Old Kings Hwy. North # 253
Darien, CT O682O
Name of Student _______________________________ male_____ female______
Parents
____________________________________________________________
Address____________________________________________________________
Town________________________________________ Telephone_____________
e-mail _____________________________________________________________
School ___________________________________Grade during Cotillion _______
The 4th and 5th grade tuition is $230.00.
The 6th grade tuition of $280.00 includes the 6th grade multi course formal dinner.
Please enclose $50.00 deposit or payment in full
Amount
enclosed _______________ Check #_______
Early registration is suggested as class size is limited.
Parents
may volunteer to sign up for a chaperone date below, if their schedules permit.
Name of parent (s) ________________________________
Chaperone date ____________________________________
***Please mark your calendar as we will be
expecting you on your chosen date. * * *
If you are interested in assisting further , please check a box
below:
Publicity □
Photography □
Writing press releases for local newspapers □
If you need any further information, please call us at
(203) 831-9382
or email us at -- thecotillion@optonline.net
Thank you,
Robin & Ed Poska, Directors
