EDIT MAIN
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LEBANON COMMUNITY UNIT SCHOOL DISTRICT #9

SPORTS HOLD HARMLESS FORM

The undersigned, as parent/guardian of _________________________________ (please print students name), a minor, do, for themselves, heirs, executors or assigns, on behalf of and for the said minor, hereby release and discharge the Lebanon Community Unit School District #9, its officers, members of its Board of Education, committees, employees and agents, from and against any and all claims, actions, demands, liabilities, losses and expenses (including attorney’s fees) relating to any and all damages (including, without limitation, injury to or death of persons and damages or loss to property), caused by, arising out of, or in any way related to, the minor’s participation in athletics and/or cheerleading during the ____________________ school year.

List any medical concerns the coaches need to be aware of:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Emergency Phone Numbers where you can be reached:

(Day) ___________________________________________________

(Evening) _________________________________________________

Signature: ____________________________________________________

Please Check One: Parent: ______ Guardian: _______

Dated this __________ day of _________________________, 20______.