Teutopolis Park District - (Teutopolis, IL) - powered by LeagueLineup.com

Music with Miss Lauren 2026 Online Registration - Sign-up Deadline: January 21st

REGISTRANT INFORMATION (Boys and Girls, 18 months to 5 years of age (but, not in Kindergarten) who live in the Teutopolis Unit 50 School District

* First Name:

* Last Name:

* Date of Birth:

* Gender:

Female

Male

Home Phone/Land Line (999-999-9999):

* Address:

* City:

* ZIP Code:

* Class:

9:00 a.m.

10:00 a.m.

PARENT/GUARDIAN INFORMATION

* Relationship to Registrant - Parent/Guardian 1:

* First Name - Parent/Guardian 1:

* Last Name - Parent/Guardian 1:

* Mobile Phone (999-999-9999) - Parent/Guardian 1:

* E-mail Address - Parent/Guardian 1:

Will Be Attending the Program with Registrant

Relationship to Registrant - Parent/Guardian 2:

First Name - Parent/Guardian 2:

Last Name - Parent/Guardian 2:

Mobile Phone (999-999-9999) - Parent/Guardian 2:

E-mail Address - Parent/Guardian 2:

Will Be Attending the Program with Registrant

Comments:

As a participant in this program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including loss of life, damage or loss which my child may sustain as a result of participating in this activity. I further agree to waive and relinquish all claims, fully release and discharge and agree to indemnify and hold harmless and defend the park district and their officers, agents, servants, and employees from any and all claims resulting from injuries, including loss of life, damages, and losses.

I AGREE TO THE STATEMENT ABOVE *

* indicates required fields