Complete this section only if your child has a pre-existing medical condition.
NOTE: If your child has a pre-existing medical limitations (i.e. allergies, asthma, diabetes,etc.) please state what they are and complete the following section:

I,__________________________________, the legal parent/guardian of __________________________________, a member of the Lebanon Little League Program, due to certain pre-existing physical limits of my child and in recognition of the potential for heirs, executors, administrators, successors, and assigns, release, acquit, waive, and forever discharge the Lebanon Little League, its agents, successors or assigns from any claims, actions, causes or expenses or compensation whatsoever we have against it or its insurer for any personal injuries arising out of our child's participation in any practice, game, or other sponsored events carried out by the League or any of its teams.

Date:__________________________ Signature:_________________________________________

Witness Signature:_________________________________________________________________