Registration | Gollatz Cotillion & Social Programs For Children

Gollatz Cotillion Registration 2024-2025

1st Child's First and Last Name * Please indicate girl or boy after name:

2nd Child's First and Last Name. Please indicate girl or boy after name.

Grade ( Fall) - School Attending

2nd Child - Grade (Fall) - School Attending

Home Address

City and Zip Code

Phone

Location

Payment

Indian Wells Country Club $315.00

La Canada at the La Canada Country Club $398.00

Tustin Ranch Golf Club $498.00

Pay by check (no additional fee) mail the Cotillion response and check to: Gollatz Cotillion, 18500 Arrrowhead Blvd. Devore Heights, CA. 92407

Name on Credit Card

Credit Card

CVV Code - on back of card

Expiration Date of credit card

If paying by credit card a $10.00 credit card service fee will be added the the membership. There is a $200.00 non-refundable fee if registration is canceled / withdrawn after 30 days of processed payment.

Optional - I would be interested in chaperoning a Cotillion event - Please choose a date:__________________________

I give my consent for my child to attend

Thank you for submitting your registration to Gollatz Cotillion. An email will be sent from the Gollatz business office regarding the status of your child's membership when processed. (joined/confirmed or on the wait list).

Quality ~ Legacy
(909) 880-8654

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