Registration | Gollatz Cotillion & Social Programs For Children

Gollatz Cotillion Registration 2024-2025

1st Child First and Last Name

Boy or Girl

Grade ( Fall) - School Attending

2nd Child First and Last Name

Boy or Girl

2nd Child - Grade (Fall) - School Attending

Home Address

Phone

City

Zip Code

Location

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 There is a $200.00 non-refundable fee if registration is canceled / withdrawn after 30 days of processed payment.

Payment

Indian Wells Country Club $315.00

La Canada at the La Canada Country Club $398.00

Senior Club (La Canada) & Life Skills $358.00

Tustin Ranch Golf Club $498.00

Partial Payments of $200.00 for deposit

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

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

I give my consent for my child to attend

Quality ~ Legacy
(909) 880-8654

ACCESSIBILITY STATEMENT

Quality ~ Legacy (909) 880-8654

ACCESSIBILITY STATEMENT

Quality ~ Legacy
(909) 880-8654