Request edit access
Baseball/Softball Intramurals
DATES:
October 8, 13, 15, 20, 22, and 27

Intramural Fees are $35.00 per student. We are offering 6 sessions for 2nd thru 4th grade classes only. Every student will need to be picked up by a parent or guardian, unless staying for After School Care. Intramurals will be held on the high school baseball and softball fields. If rained out, we will use the elementary gym and parent pick-up will be behind the gym.

Please fill out the information below to sign your student up for our district Intramural Sports Program. If you are signing up multiple siblings, please fill out the form once per student. Parent pick-up will be at 4:15. SIGN-UP and PAYMENT deadline is Wednesday, October 7. 
Email *
Student's first name:
Student's last name:
Choose one:
Clear selection
Grade level:
Clear selection
Student pick-up will be at 4:15
Clear selection
Parent/Guardian first and last name:
Parent/Guardian phone number:
Emergency contact first and last name:
Emergency contact phone number:
List any medical concerns:
List your child's medical doctor:
List your child's medical doctor's phone number:
List your child's insurance carrier and policy number:
MEDICAL RELEASE:
Lebanon Community Unit School District #9 has our permission, in the event of an emergency and in the case we are unavailable, to authorize any physician, nurse practitioner, or medical personnel to examine, interview, test and if necessary, treat my child as they deem advisable.  By signing up your student, you as the parent/guardian of the above 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 of property), caused by, arising out of, or in any way related to, the minor's participation in Intramural Sports Activities during the 2026-2027 school year. 
PARENT STATEMENT:
I hereby state that my child is in good mental and physical health condition to participate in the activities provided by the LCUSD9 Intramural Sports Program. I hereby release LCUSD9 employees and staff, from liability to the name listed below if injury to the person or property of the above names occurs on the premise of LCUSD9. I understand that LCUSD9 has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my son/daughter/child engages in inappropriate conduct. I further confirm that the information contained in the application is correct to the best of my knowledge.
List student's name:
I agree to the PARENT STATEMENT listed above:
Parent/legal guardian name and date:
PAYMENT:
Sign-up and Payment of $35.00 per student will need to be made by Wednesday, October 7. You can pay with MySchoolBucks OR send in cash or check in an envelope with your student's name marked Baseball/Softball Intramurals. Thank you!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lebanon C.U.S.D. #9.

Does this form look suspicious? Report

Google Forms