Womens Summer League – Renegades Basketball Inc.

Name

Address

City

State/Province

Zip/Postal

Cellphone or Phone

Email

Birth Date

Height

Shirt Size

Position

High School

High School Year of Graduation

College

College Year of Graduation

Division (please indicate)

D-2

D-3

Other

Other Division from above

Please check if YES

ARE YOU ENTERING WITH YOUR SCHOOL TEAM?

WANT TO BE DRAFTED ONTO A TEAM?

WANT TO BE DRAFTED WITH ANOTHER PLAYER/PLAYERS? Please List below

Draft me with these players

$160 Fee includes league shirt, gym rental time, ref fees, scorekeepers, awards & insurance.
All payments must be made with credit card on Renegades website: www.renegadesbasketball.com

Questions: Contact Dave Kessler: deucedbk@gmail.com ot deucedbk@comcast.net or text 215-518-7877

I hereby assume all risks associated with my participation in the 2024 Phila/Suburban Womens Summer Basketball League, and agree to hold harmless David Kessler and the Phila/Suburban Womens Summer Basketball League organization and their Administrators, Coaches and Referees and also the Renegades Inc organization, their officers, coaches, and participants for any and all claims or injuries and illness such as communicable diseases including COVID-19, arising out of the participation in this program. I 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 I am covered by such a plan. I the undersigned player do hereby grant permission to any licensed physician to perform or provide necessary medical care or aid to myself if injured in connection to the playing of basketball at Renegades Gym.

Player Signature

Date

Parent Signature if player under 18 years old

Signature Date – Parent