Walker League Registration

JOHN WALKER MEMORIAL FALL LEAGUE
BOYS AND GIRLS 2016 REGISTRATION FORM Grades 5 thru 12 LEAGUE BEGINS FRIDAY 8/26 & SUNDAY 8/28, except 5th & 6th girls division begins Monday 9/12 and 3rd/4th Grade boys & girls division begins Saturday 9/10

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.
$140.00 Fee - Additional $100.00 separate check to play up in older age div. only if space available (if approved) and $125 for 3rd and 4th
Players that request it & are approved to play up must also play their own age.
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
Birthdate:
Height:
Address
City
State
Zip Code
Mom Cell Phone
Mom Name
Dad Name
Dad Cell Phone
Home Phone
E-mail

Shirt Size

 

School Grade Fall 2016

 
Players School

Player Bball Performance Rating

 

What position does child play? (Please check)   Guard  Forward

Please describe player's bball experience yrs. AAU, Travel etc? 
List a few friends you would like on team if possible: 
Or if coming in on full outside team: 
Team Name
Coach Name

PARENTAL PERMISSION

My child has my permission to participate in the 2016 John Walker Memorial Fall 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

MANDATORY INSURANCE -

Any player who does not play AAU basketball or plays AAU basketball with another club must register online at:

GO TO: https://play.aausports.org/summary.aspx  OR go to aausports.org click "JOIN NOW" and on right is "CONTINUE AS GUEST USER".  When you register online, you must selectAB (extended benefit) and you will be covered under the AAU supplemental insurance from 8/16/16 to 8/31/17. This is not going to be available on the aausports.org website until August 16th. This insurance covers the player not only for basketball but for any sport that the player participates in during the entire year and is well worth the $16.00.  This AAU insurance does not take the place of family health care coverage.  Every Walker League player must have their own health care insurance. All Non-Renegades players must forward by email , their AAU insurance membership card confirmation they receive from AAU to parenegades@comcast.net prior to playing in their first league game. This will be strictly enforced due to the liability issues.  If you have any questions please contact us at  parenegades@comcast.net .  I look forward to seeing you this fall season and having each of you continue to work towards being the best that you can be.

Walker League Schedule and Rosters will be posted at www.renegadesbasketball.com by Thurs Aug 25th. Sun Schedule and Rosters will be posted by Sat Aug 27th and the following Sat Schedule and Rosters will be posted by Fri Sept 9th.  You must check our website in order to know when your first game will be played.  We won't be able to telephone.

 

If you wish to pay by credit card please submit this form and then go back on home page of our website and click on "Make Payments" or you can mail a $140.00 check for 5th grade & up or $125 for 3rd/4th grade, payable to Renegades, 858 Street Rd., Southampton, PA 18966 (mailing address)                                                                          

Please send payment by early reg deadline of 8-1-16.



 
Copyright 2016 [Renegades Basketball]. All rights reserved.
Revised: 09/14/16