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Tennis Clinics 2024 Online Registration - Sign-up Deadline: May 1st
REGISTRANT INFORMATION (A student in the Teutopolis Unit 50 School District)
*
First Name:
*
Last Name:
*
Date of Birth:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2012
2013
2014
2015
*
2023-2024 Grade:
Third Grade
Fourth Grade
*
Gender:
Female
Male
Home Phone/Land Line (999-999-9999):
*
Address:
*
City:
*
ZIP Code:
PARENT/GUARDIAN INFORMATION
Do not provide work phone if not allowed to take phone calls at work.
*
Relationship to Registrant - Parent/Guardian 1:
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Other
*
First Name - Parent/Guardian 1:
*
Last Name - Parent/Guardian 1:
*
Mobile Phone (999-999-9999) - Parent/Guardian 1:
Work Phone (999-999-9999) - Parent/Guardian 1:
*
E-mail Address - Parent/Guardian 1:
Relationship to Registrant - Parent/Guardian 2:
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Other
First Name - Parent/Guardian 2:
Last Name - Parent/Guardian 2:
Mobile Phone (999-999-9999) - Parent/Guardian 2:
Work Phone (999-999-9999) - Parent/Guardian 2:
E-mail Address - Parent/Guardian 2:
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
SELECT FEE
$15.00 - I live in the Teutopolis Unit 50 School District.