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: ______________________________________________________________________________________
Which Program are you Registering For?
___ AAU Tryouts ___ Preseason Skills Sessions ___ Spring In House Program ___Spring Weeknight Skills
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/Quaker Valley (Sewickley) ____Sports & Courts North (Wexford)
____ Southpointe Courthouse (Canonsburg) ____ Cool Springs Sports Complex (Bethel Park)
____Gateway High School (Monroeville)
Do you have any Teammate or Coach Requests? ___________________________________________________
(These are not guaranteed!)
Do you have any uniform # requests? _________________________ (Not guaranteed)
If you are registering for any of the AAU Preseason Skill Development Programs (Open Gyms/Boot Camps/Academies/Workouts), how many session?
Number of Sessions: ___ 1 ($35) ___ 3 ($100) ___ 5 ($150) ___ 10 ($275) ___ 20 ($400)
Please List Dates & Sites (if available): _______________________________________
BSA Gear Options: ___BSA Practice Jersey ($25) ___BSA T-Shirt ($10) ___BSA Game Jersey ($35) ___BSA Game Shorts ($35) ___BSA Dry Fit Short Sleeve Shirt ($25)___BSA Dry Fit Long Sleeve Shirt ($25) ___BSA Sneaker Bag ($15) ___BSA Hoodie ($35) ___BSA Sweatpants ($35)
Waiver: I understand that I am enrolling my child in the Basketball Stars of America AAU Program and that the Basketball Stars of America LLC, Coach Daryn Freedman, and 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! If a player is injured and can’t continue, he or she will receive a prorated credit towards another BSA program. I also give permission for photos/videos taken during practices and games of my child to be used on the BSA Web Site and other promotional materials.
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