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Cotillion 2024-2025 Enrollment Form PaymentIf you wish to pay with a check, or prefer to return this form by mail, please return to the cotillion page, download the printable form and send the form and the check by mail.Name of Student* Gender* Male Female School in the Fall 2024* Grade in the Fall 2024*Please enter a number from 1 to 12.Additional Student Gender Male Female School in the Fall 2024 Grade in the Fall 2024Please enter a number from 1 to 12.Address* Street Address Address Line 2 City AlabamaAlaskaAmerican 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 Best Phone During Event*Parent's Name* Email* If returning what does your child like most and/or how can we improve your child’s experience:Food AllergiesPlease note that we do serve a small cupcake and lemonade at each event. If your child has food allergies, please feel free to bring in a treat for them and we will make sure they get it. General ReleaseIn consideration for my child’s (children’s) participation in Courteous & Cool Cotillion, I hereby release, waive, discharge and covenant not to sue Courteous & Cool Cotillion, its owners, directors, officers, servants, agents and employees (hereinafter referred to as “releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury, that may be sustained by my child, or to any property belonging to me or my child, whether caused by the negligence of the releasees, or otherwise, while participating in the Cotillion, or while in, on or upon the premises where the Cotillion is being conducted, while in transit to or from the premises, or in any place or places connected with the Cotillion. I submit that I am aware of all risks and that I am the guardian of my child and hereby have the right and power to sign this release. Accept the terms of the General Release* I Accept Release for use of Photographs and/or VideoI grant permission to Courteous & Cool Cotillion to use photographs and/or video taken of my child during any cotillion events for use in Courteous & Cool Cotillion’s publications such as advertisements, its web sites or other electronic forms of media, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph(s). I am the guardian of my child and hereby have the right and power to sign this release. Accept the Photographic/Video Release* I Accept HiddenHow did you hear about us? Postcard Internet Friend School Girl Scouts Returning Other How did you hear about us? Post card Internet Friend School Girl Scouts Returning HiddenOther (please describe)Please sign this form to acknowledge acceptance of all terms.*Date* MM slash DD slash YYYY