Walker League Registration

JOHN WALKER MEMORIAL FALL LEAGUE
**League starts the weekend of Fri, Aug 25 & Sun, Aug 27 for 3rd thru 12th grades (Except 5th/6th girls start Mon. Sept 11th)

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.
$120.00 Fee - Additional $100.00 separate check to play up in older age div. only if space available (if approved)
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 2017

 
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 2017 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:

All Township, School, CYO or AAU teams need to give us current proof of insurance. If you are a township, school, CYO or AAU team that does not have current player insurance coverage then all players and coach will need to purchase aau membership card at a cost of 16.00 which will provide the player catastrophic insurance for the period Aug 15, 2017 thru Aug 31, 2018. Please forward copy of aau membership card to parenegades@comcast.net prior to first game.

If you are entering as an individual and you are not a Renegade club member you will need to purchase an aau membership card at a cost of 16.00 which will provide the player catastrophic insurance for the period Aug 15, 2017 thru Aug 31, 2018. Please forward copy of aau membership card to parenegades@comcast.net prior to first game.

 AAU Membership insurance cards can be purchased online at www.aausports.org beginning on Aug 16, 2017. Do not purchase aau card prior to Aug 16th because that membership will expire on Aug 31st, 2017. Click on "Register Now" and you must select EXTENDED $16 (not $14)/AB (added benefit) and you will be covered under the AAU supplemental insurance from 8/16/17 to 8/31/18. This does not take the place of your own family insurance which is required to play in league.

Walker League Schedule and Rosters will be posted at www.renegadesbasketball.com            You must check our website in order to know when your first game will be played. We won't be able to telephone.

If player is entering as an individual, it is very important to fill in your child's height and basketball experience on individual registration form. We must have this info in order to place your child on a team. We try to make the level of all of the teams as even as possible so that the games are competitive.

Checks payable to: RENEGADES, 858 Street Rd., Southampton, PA 18966 or pay online with credit card at

www.renegadesbasketball.com Register early by July 25th to secure spot or by deadline of August 15th, 2017.  (waiting list last year)

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 $120.00 check for 3rd grade & up, payable to Renegades, 858 Street Rd., Southampton, PA 18966 (mailing address)                                                                          



 
Copyright 2017 [Renegades Basketball]. All rights reserved.
Revised: 07/12/17