Renegades Club Registration

Renegades Basketball

Club Registration Form

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 Girls   Boys
Street Address  
City  
State  
Zip Code  
BirthDate  
Current Grade  
Home Phone
Mom's Name
Mom's Cell
Dad's Name
Dad's Cell
Parent Email
School
Height

Player Adult Shirt Size

  

Player Adult Shorts Size

  

Please go back to website and make payment after submitting this form!

Copyright 2009 [Renegades Basketball]. All rights reserved.
Revised: 03/23/10