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

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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:

* 2023-2024 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:

* 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:

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