Renegades DA Men's League Registration

Determined Athletes Mens League Individual Player Registration

18 and Over & 35 Over

Please note we can only have a 35 and over division if enough teams register League Begins Wednesday September 5, 2018 Gym location is Renegades Kelly Bolish Gym, 2950 Turnpike Dr., Hatboro, PA 19040 Games to be played every Wednesday night at 7pm, 8pm, 9pm Deadline to register is Saturday, September 1st, 2018 Schedule will be posted online at www.renegadesbasketball.com

Checks Payable to: RENEGADES, 858 Street Rd., Southampton, PA 18966
Gym Location is Renegades Kelly Bolish Gym, 2950 Turnpike Dr., Hatboro, PA
Cost: $850.00 per team for 8 games plus playoffs (200.00 Team Deposit & Registration due by Sat, Sept 1, 2018)
 Note: Please fill in shirt size and Team Captain

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

Renegades Basketball - 858 Street Rd. - Southampton, PA 18966     Pay by credit card by clicking here!


Player Name
Gender: Male   Female
Division: Over18   Over35
Birthdate:
Height:
Address
City
State
Zip Code
Cell Phone
E-mail

Adult Shirt Size

 
Team Captain
   

1. 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.

2. I hereby assume all risks associated with my participation in the Renegades Determined Athletes Men’s League Program and agree to hold harmless the Renegades Organization, their officers, coaches and participants for any and all claims or injuries arising out of participation in the Renegades Determined Athletes Men’s League.

 3. I have completed and understand the details of this form and attest to its accuracy. I hereby grant permission to any licensed physician to perform or provide necessary medical care or aid to me if injured in connection to the playing of basketball TEAMS COMING INTO THE LEAGUE SHOULD HAVE THEIR OWN INSURANCE

(signature)(date) 


 
Copyright 2018 [Renegades Basketball]. All rights reserved.
Revised: 09/03/18