Club Registration


2019/2020 Club Registration (8-15-19 thru 8-31-20)

2019/2020 Fee is $175 for team players (non-refundable) - $125 for 2nd child, $75 for 3rd child, $25 for 4th child     Drills only fee of $225.00 for non-team members and 2nd & 3rd children from same family, take $25 off each. Winter Team Member $100- Not for "drills only" participation/membership - $100 fee for our Winter Team Players ONLY  (Sept 1 2019 thru Feb 29 2020)

Please send a copy of your child's state certified birth certificate to the office if you are a brand new member

Please use the form below to register and send payment to:   Renegades - 858 Street Road - Southampton, PA. 18966


 Or pay securely on-line by clicking here 

Please provide the following contact information per player:

Player Name  
Birth Date  
Girls or Boys age on Sep 1, 2019


  Only brand new Renegades need to fill in UNIFORM info below:
Shirt Size


 Short Size


Uniform # Request - Top 5 picks:

Previous Experience

Height (nust be entered)


Grade (2019/20 School Year)
Player Street Address  
Address (cont.)
Zip/Postal Code  
Mother's Name
Father's Name
Mom's Cell Phone
Dad's Cell Phone
Home Phone  
Mom's E-mail (Club Use Only)  
Dad's E-mail (Club Use Only)  
Emergency Phone  
Dr.'s Name/Phone  
Health Ins Co Name  
Health Ins Co ID#  

Participants Medical History & Permission Statement - Must be completed by Parent or Guardian


Has your child ever been treated by a Doctor for, or experienced, any of the following?  Please check Yes or No:

Head Injury: No   Yes
Concussion:  No   Yes
Dizzy Spells: No    Yes
Asthma:    No   Yes
Fainting: No   Yes
Anemia: No    Yes
Back Injury:  No   Yes
Diabetes:   No   Yes
Fatigue: No    Yes
Heart Problem: No   Yes


Is your child allergic to any drugs, serums, adhesive tapes or insects?
Drug Allergy No    Yes

Please explain:

Is your child allergic to any food or other substances?
Food Allergy No    Yes


 Please explain:

Has your child ever been told not to participate in sports because of a health problem?
Health Problem No    Yes


Please explain:

Does your child take medication regularly?
Medication No    Yes


Please list medications:


Has your child had any serious illness or operation in the past year? 
Operation No    Yes


Please explain:


Is your child currently under a Doctor's care? 
Doctor Care No    Yes


Please explain:

Is there any medical condition that would limit your child's participation in our program?  
Medical Condition No    Yes


Please explain:




(Player's Name) has my permission to participate in the Renegades Basketball program.  I hereby assume all risks associated with the participation of my child in the Renegades Basketball program and agree to hold harmless the Renegades organization, its officers, coaches, and participants for any and all claims for injuries arising out of participation in this program.  I have completed and understand the details of this form and attest to its accuracy.  I certify that my child has primary health insurance with the above carrier.  I also give permission for my child to be examined and treated by a physician in case of emergency.


Important info for brand new Renegades members joining 8-15-19 thru Spring 2020: During the fall/winter of 2004 the Renegades Organization built a brand new 3 court facility inside a warehouse at 2950 Turnpike Dr., Hatboro, PA. All Renegades™ families at that time either procured $500.00 worth of advertising sponsorships from local businesses or contributed a personal tax deductible donation in that amount. All brand new members that register with the club on August 15, 2019 thru the spring of 2020 will not be responsible for this obligation during their first year of participation with the Renegades. However, if you choose to re-register for your second year with us on the following Aug 15, 2020, then the first building fund sponsorship/contribution installment of $125 will be due.(Because of the current economic conditions familes can spread out the 500.00 building sponsorship donation over a period of four years instead of having to contribute one lump sum). And for all those families that are re-registering for a second year with us on Aug 15, 2018 or later, the $125.00 yearly donation will be due on Feb 1, 2019 and needs to be paid prior to the player participating in 2020 spring AAU evaluations. Or you have the option of obtaining a yearly business sponsorship of $125.00 per year for 4 years.
I have read and understand the above paragraph about the gym fundraising campaign.



Signature (Parent / Guardian):   Date:  



Checks made out to: Renegades Basketball

Mail to: Renegades Basketball 858 Street Road, Southampton, PA  18966 or Register Online


Copyright 2019 [Renegades Basketball]. All rights reserved.
Revised: 07/11/19