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Soccer Intramurals 2024-25
Soccer Intramurals Dates and Times:
Thursday, May 1st
Tuesday, May 6th
Thursday, May 8th
Tuesday, May 13th
Thursday, May 15th
Weather permitting we will be on the HS Soccer Field

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 the form out once per student.  The Soccer Intramural Fee is $30.00 per student for 5 sessions.  The deadline to sign-up and pay is Wednesday, April 30th. 
Email *
Untitled Title
Name
Student's last name:
Grade level:
Clear selection
How will your child get home after intramurals?
Clear selection
Parent/guardian first and last name:
Parent/guardian phone number:
Secondary/Emergency contact first and last name:
Secondary/Emergency contact phone number:
List any medical concerns for your child:
List your child's medical doctor and 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 2024-2025 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 LCUSD#9 Intramural Sports Program. I hereby release LCUSD#9 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 LCUSD#9. I understand that LCUSD#9 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 terms listed above.
List parent/legal guardian name and date:
PAYMENT:
Payment of $30.00 per student will need to be made by WEDNESDAY, APRIL 30th. You can pay with myschoolbucks OR send in cash or check in an envelope with your student's name marked Soccer Intramurals. If you have any questions call Lori at (618) 531-8014, or email: lreinneck@lcusd9.org.  
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