2024 Crimson & Cream Cotillion Sign-Up
Cotillion Sign-Up form and official transcripts must be submitted by March 1, 2024. Transcripts can be sent via mail or email. Please email transcripts to: dstcotillionpeoria@gmail.com. Please mail transcripts to: Delta Sigma Theta – Peoria Alumnae Chapter, Attn: Cotillion Committee, P.O. Box 386, Peoria, IL 61651-0356
Future Debutante Information
All debutantes must be current 12th grade High School students, and will not reach the age of 20 by graduation.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
High School
*
Age
*
Birthday
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Parent/Guardian Name
First Name
Last Name
Secondary Parent/Guardian Phone Number
Please enter a valid phone number.
Secondary Parent/Guardian Email
example@example.com
Father Figure and Escort Information
Escorts must be between the ages of 14-19. If you have an idea of who your escort will be, please include their contact information below - even if you have not confirmed their participation.
Father Figure's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Escort's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Back
Next
Parent's Signature Below - I grant permission and support for participation in the 2024 Crimson & Cream Cotillion
*
Parent's Signature Below - I understand that all fees and ad sales are non-refundable
*
Debutante's Signature Below - I understand that all fees and ad sales are non-refundable
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
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