2012 Basketball Stars of America Spring AAU Tryouts & In House Basketball Program Registration Form:

Name: ______________________________________________________ Date of Birth: _________

Age: _________  Grade: _________ School: ____________________________________________

Height: ________ Primary Position: ________ Uniform Size: ______ Sneaker Size: ______ Sex: Male/Female

Home Street Address: __________________________________________________________________

City: _______________________________________________ State: ____________ Zip: __________

Cell Phone Numbers: _________________________________________________________________

Home/Work Phone Numbers: __________________________________________________________

Email (s): ___________________________________________________________________

Twitter: _____________________________________

What are you registering for?
_____ 2012 Spring AAU Tryouts ($50)
_____ 2012 Spring In House Program ($400)

Which Practice Site do you prefer? (You may check off the one you want or rank them if more than one will work)
_____ Sewickley Academy _____ Hillcrest Christian Academy (South Hills)
_____ Kiski School _____ Shady Side Academy _____ Erie Family First Sports Park

Do you have any Teammate or Coach Requests? ___________________________________________________
(These are not guaranteed!)                                                   

Do you have any uniform # requests? _________________________ (Not guaranteed)

Are you registering for any of the preparation programs (Open Gyms/Boot Camps/Academies/"BSA Elite" Workouts)?

Number of Programs: ___ 1 ($35) ___ 2($70) ___ 5 ($150) ___ 10 ($250) ___ 20 ($400)

Please List Dates & Sites: _______________________________________

BSA Gear Options: ___ BSA Practice Jersey ($25) ___ BSA T-Shirt ($10) ___ BSA Shorts ($25) ___ BSA Dry Fit Shirt ($25) ___ BSA Sneaker Bag ($15) ___ BSA Duffel Bag ($25) ___ BSA "TEAM" Wristbands ($1)

                                
Waiver: I understand that I am enrolling my child in the Basketball Stars of America AAU Program and that the Basketball Stars of America, Coach Daryn Freedman, Hoop Mountain, any facilities that are used or any coaches will not be liable for any injuries incurred during participation in the program. I also understand that there are no refunds for the Tryout Fee or Tuition Fee! If a player is injured and can't continue, he or she will receive a prorated credit towards another BSA or Hoop Mountain program.

Signature of Parent/Guardian: _____________________________________ Date: ______________

Please mail completed registration form along with a check made out to: Basketball Stars of America LLC
To: Basketball Stars of America LLC, c/o Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108