Renegades Summer Hoops Registration

Summer Hoops League
Boys and Girls 3rd Grade through 10th Grade

Checks Payable to: RENEGADES, 858 Street Rd., Southampton, PA 18966
Gym Location is Renegades Kelly Bolish Gym, 2950 Turnpike Dr., Hatboro, PA
Cost: $120 per player or $1200 per team/10 players minimum/13 max to roster.

Due: Registration deadline is Mon, June 12th, 2017.
Note: Please fill in your child's grade & height and his/her shirt size!

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: Girl   Boy
Birthdate:
Height:
Address
City
State
Zip Code
Mom Name
Mom Cell Phone
Dad Name
Dad Cell Phone
Home Phone
E-mail

Adult Shirt Size

 

School Grade Fall 2017

 
Players School
Please describe player's bball experience if new Renegades player NOT known to Mr. Flynn 
List a few friends separated by commas, you would like on team: 
If entering as a member of a team enter Coach's Name:
If entering as a member of a team enter Team Name:
   

PARENTAL PERMISSION

My child has my permission to participate in the 2017 Summer Hoops League.  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: 03/29/17