Overtime League Registration

2017-2018

Basketball League


**League starts Saturday December 16, 2018
Checks Payable to: RENEGADES, 858 Street Rd., Southampton, PA 18966
Gym Location is Renegades Kelly Bolish Gym, 2950 Turnpike Dr., Hatboro, PA and other area gyms if needed.
If entering as an individual to be placed on a Renegades team league fee is $175.00.which includes team practices and club membership registration is also required for Renegades’ team players

If entering as a player on an outside team your Coach will submit payment for entire team.
 Note: Please fill in your child's grade & height and his/her shirt size!

Please use the form below to register and make payment by mail or credit card to:

Renegades Basketball - 858 Street Rd. - Southampton, PA 18966   


Player Name
Gender: Girl   Boy
Birthdate:
Height:
Address
City
State
Zip Code
Mom Cell Phone
Mom Name
Dad Name
Dad Cell Phone
Home Phone
E-mail
If you already have Renegades winter jersey (Girls' Gray Shirt/Boys Reversible) What is the Jersey Number?

Shirt Size

 

Shorts Size

 
Jersey Number Requests. Top 5 jersey number choices, separate by commas

School Grade Fall 2017

 
Players School
Or if coming in on full outside team: 
Team Name
Coach Name

PARENTAL PERMISSION

My child has my permission to participate in the 2017-2018 Winter Program. . I hereby assume all risks associated with the participation of my child in the Renegades Program, and agree to hold harmless the Renegades AAU organization, their officers, coaches, and participants for any and all claims or injuries arising out of participation in the Renegades program. I have completed and understand the details of this form and attest to its accuracy.

All persons are required to be covered by a personal or family medical plan including hospitalization before they can participate in the program.

I certify that the person named above is covered by such a plan.

I the undersigned parent (legal guardian), do hereby grant permission to any licensed physician to perform or provide necessary medical care or aid to my child or ward who was injured in connection to the playing of basketball.

Signature          Date



 
Copyright 2017 [Renegades Basketball]. All rights reserved.
Revised: 10/20/17