Prince George's County Department of Parks and Recreation
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2014 Teen Cotillion Participant Application

Please register below to access the Teen Cotillion application. After you register, you will receive log-in information to complete application questions, including three short essay questions. Only 20 female and 20 male applicants will be selected to participate. All applicants must be residents of Prince George’s County, Maryland, and must be between 14 and 17 years old (as of January 7, 2014). Completed applications must be received by Friday, November 8, 2013.
Already registered, log in here.
Email Address
Password
Confirm Password
Name
Date of Birth
School
Grade
G.P.A.
Gender Male Female
Street Address
City, St., Zip

Phone - -
Local Community Center
M-NCPPC Youth ID#
Are you involved in the Xtreme Teens Program?
Frequently Occasionally New Member
Parent/Guardian Information
Name
Street Address
City, St., Zip
Check if same as above

Day Phone - -
Evening Phone - -
Email
Will you need assistance finding a dance partner for the Parent/Guardian dance routine?
Yes No
The Department of Parks and Recreation encourages and supports the participation of individuals with disabilities. Register at least two weeks in advance of the program start date to request and receive an accommodation.