Overtime League Registration


Basketball League

**League starts Saturday December 15, 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
Zip Code
Mom Cell Phone
Mom Name
Dad Name
Dad Cell Phone
Home Phone
Do you currently own/fit the winter style Renegades uniform (boys reversible or girls gray cotton shirt)? Y/N
If so, what is the jersey number?

Shirt Size


Black Winter Style Short Sizeif needed


School Grade Fall 2018

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


My child has my permission to participate in the 2018-2019 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 2018 [Renegades Basketball]. All rights reserved.
Revised: 10/17/18