Basketball Stars of America Fall Program Registration Form

Name: ________________________________________________ Date of Birth: _____________________

Age: _________  Grade: _________ School: __________________________________________________

Height: ____________      Primary Position: ___________      Shirt Size: ____________   Sex: Male/Female

Home Street Address: ____________________________________________________________________

City: ____________________________________________ State: __________ Zip: __________________

Phone Numbers: ________________________________________________________________________

Email: ________________________________________________________________________________
Discount Code: ____________________________________
Teammate or Coach Requests: _____________________________________________________________
Waiver:
I understand that I am enrolling my child in the Basketball Stars of America Program or affiliated program and that the Basketball Stars of America and any affiliates, Coach Daryn Freedman, Hoop Mountain PA, Sewickley Academy or any coaches or facilities used will not be liable for any injuries incurred during participation in the program. I also understand that there are no refunds! If a player is injured and can’t continue, he or she will receive a prorated credit towards another BSA or affiliated program.

Signature of Parent/Guardian:  ______________________________________    Date: _______________
Programs: Please check all attending
____ Fall AAU Basketball Leagues @ Sewickley Academy:
___ JR NIT ___NIT ___NCAA ___NBA East ___NBA West ___ WNCAA ___WNBA
____ BSA Weeknight Fall Leagues @ Hillcrest Christian Academy:
___NIT ___NCAA ___NBA East ___NBA West ___ WNCAA ___WNBA
____ BSA Weeknight Fall Leagues @ Aquinas Academy:
___NIT ___NCAA ___NBA East ___NBA West ___ WNCAA ___WNBA
____ BSA Weeknight Fall Leagues @ Kiski Prep School:
___NIT ___NCAA ___NBA East ___NBA West ___ WNCAA ___WNBA
____ BSA Jersey ($25) Size: ______
____ BSA Shorts ($25) Size: ______
____ BSA Shooting Shirt ($25) Size: _____

____ Sunday Basketball Boot Camps - ____ Full Season ($250) or ____ # of sessions ($35/each)
____ BSA Academies:  ___ Point Guard Academy ___ Shooting & Scoring Academy ___ Post Player Academy
For Academies: _____ Full Season ($250) or _____ # of sessions ($35/each)
____ Sunday Elite High School Player Workout - ____ Full Season ($250) or ____ # of sessions ($35/each)
____ “BSA Elite” Workouts  - ___ 10 Sessions ($250) ___ 20 Sessions ($400) or ____ # of sessions ($35/each)
____ Individual Instruction Workouts - _____ # of sessions - ____ 1 on 1 or ____ Group
____ Basketball Mini Camps: ___Columbus Day (10/10)  ___ Halloween (10/31) ___ Black Friday (11/25)
Fall Showcase Events:
____ HM Recruiting Showcase 1 (9/24)  ____ Pittsburgh Boys Recruiting Night (10/6)
____ Pittsburgh Basketball Report Best of Pittsburgh (10/29): ____ Boys  ____ Girls
____ HM Recruiting Showcase 2 (11/5)
____ Fall Showcase Special: 4 Boys Events for $200
Fall Tournaments:
List Events Attending & Team: ________________________________________
*Tournament Registration forms available at www.basketballstarsofamerica.com               

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