2017 Basketball Stars of America Fall Programs Registration Form:

Name: ______________________________________________________ Date of Birth: _____________________
Age: _________  Grade: _________ School: ________________________________________________________
Height: ____________      Primary Position: ___________     Uniform Size: ____________   Sex: Male/Female
Home Street Address: ___________________________________________________________________________
City: _______________________________________________ State: ____________ Zip: ____________________
Phone Numbers: _______________________________________________________________________________
Email: _______________________________________________________________________________________
Discount Code: ____________________________________
Teammate, Coach or Number 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, 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. I also understand that my child’s picture or team picture may be used in future BSA advertising material.
Signature of Parent/Guardian:  ______________________________________________________________                  Date: ____________________

Programs: Please check all attending:

Choose The Program You Are Registering For:
____ 2017 Fall AAU Basketball Program
____ 2017 Fall In House Basketball Program
____ 2017 Fall Weekend Basketball Skills Program – Choose Skills Program Below
____ 2017 Fall Weeknight Basketball Skills Program
____ 2017 Fall Individual Basketball Player Showcases – Choose Showcase Below
____ 2017 Fall Basketball Mini Camps – Choose Camp Below

Choose The Location You Prefer:
____ Pittsburgh North Hills: Sports & Courts North in Wexford, PA
____ Pittsburgh South Hills: Southpointe Courthouse in Canonsburg, PA
____ Pittsburgh South Hills: Cool Springs Sports Complex/Hillcrest Christian Academy in Bethel Park, PA
____ Monroeville: Monroeville Sports Center in Monroeville, PA
____ Pittsburgh Indoor Sports Arena in Fox Chapel Area/Cheswick, PA
If Choosing Weekend Basketball Skills, Choose Your Skills Programs:
____ Basketball Boot Camp
____ BSA Elite Shooting & Scoring Academy
____ BSA Ultimate Guard Academy
____ BSA Ultimate Forward/Center Academy
____ Mix & Match – ___ # of Sessions
If Choosing Individual Basketball Players Showcases, Choose Your Dates & Showcases:
____ Sunday, October 1st at Southpointe Courthouse: Which Showcase: ________________________
____ Saturday, October 28th at Southpointe Courthouse: Which Showcase: ____________________________

If Choosing Basketball Mini Camps, Choose Your Camps:
____ Columbus Day – Monday, October 9th at Sports & Courts _____ or Monroeville Sports Center _____
____ Election Day – Tuesday, November 7th at Southpointe Courthouse _____ or Monroeville Sports Center _____
____ Thanksgiving Monday – Monday, November 27th at Sports & Courts _____ or Monroeville Sports Center _____
BSA Gear Options (Check all Ordering):
____ BSA Game Uniform Set ($100) – Includes Game Jersey, Game Shorts & Shooting Shirt – Size: _____
____ BSA Game Jersey ($35) – Size: _____
____ BSA Game Shorts ($35) – Size: _____
____ BSA Shooting Shirt ($30) – Size: _____
____ BSA Workout T-Shirt ($10) – Size: _____
____ BSA Practice Jersey ($25) – Size: _____
____ BSA Sneaker Bag ($15)
____ BSA Hoodie ($35) – Size: _____
____ BSA Sweatpants ($35) – Size: _____

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