test "*" indicates required fields 1Student(s) Information2Parent Information3Billing Information I am registering:*Check all that apply 5th Grade Student(s) 6th / 7th Grade Student(s) Register Your 5th Grade StudentsClick the "Add 5th Grade Student Button" to start adding in your student's registration. Please enter your child's name, grade, school information. Please choose the specific class for which you are registering each child under the Class/Gender column. If you don't see the option for your child, that means the class is FULL. Any registrations submitted without specifying the class and gender are not valid. First Name Last Name Class / Gender Actions Edit Delete There are no 5th Grade Students. Add 5th Grade Student Maximum number of 5th grade students reached. Register Your 6th/7th Grade StudentsClick the "Add 6th/7th Grade Student Button" to start adding in your student's registration. Please enter your child's name, grade, school information. Please choose the specific class for which you are registering each child under the Class/Gender column. If you don't see the option for your child, that means the class is FULL. Any registrations submitted without specifying the class and gender are not valid. First Name Last Name Class / Gender Actions Edit Delete There are no 6th/7th Grade Students. Add 6th/7th Grade Student Maximum number of 6th/7th grade students reached. Photo Release* I agree to grant Cotillion Academy permission to use photographs of my child(ren) on our website, on social media and/or in releases to the media.If there are extenuating circumstances regarding the photo release, please email us at [email protected]. Parent Contact Information Relationship to Child Name Actions Edit Delete There are no Parents. Add Parent Maximum number of parents reached. Siblings InfoTo assist with our records for future classes, please list younger brothers and sisters below and indicate the year entering 5th grade. First Name Last Name Year Entering 5th Grade Actions Edit Delete There are no Siblings. Add Sibling Maximum number of siblings reached. Name* PrefixMr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Registration Fee Total Price: $0.00 Credit Card*Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged. Δ