2011-2012 Basketball Stars of America Camp Registration Form
Name: _____________________________________________ Date of Birth: _________
Home Street Address: _________________________________________________
City: _________________________________________ State: __________ Zip: ______
Age: _________ Grade: _________ School: ___________________________________
Height: __________ Primary Position: ________ Shirt Size: __________ Sex: Male/Female
Cell Phone Numbers: ____________________________________________________
Home Phone: _______________________________________________________
Email: __________________________________________________________
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:
Basketball Camps at Hillcrest Christian Academy:
____ Winter Break Basketball Camp - $175 for all 4 days
____ Winter Break Camp by The Day @ $50/day - Days: ____________________
____ MLK Day Mini Camp (January 16, 2012) - $50
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