2011-2012 Basketball Stars of America Winter Program Registration Form

Name: ____________________________________________________ Date of Birth: _________
Age: _________  Grade: _________ School: __________________________________________
Height: ____________  Primary Position: ___________   Shirt Size: __________  Sex: Male/Female
Home Street Address: ____________________________________________________________
City: ____________________________________________ State: __________ Zip: ___________
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
____ Sewickley Winter AAU Sunday Basketball Leagues:
___ Jr NIT ___NIT ___NCAA ___NBA East ___NBA West ___WNCAA ___WNBA
____ Jersey Fee (if needed - $25) - Size: ___________
Gear Options: ___ BSA T-Shirt ($10) ___ BSA Shorts ($25) ___ BSA Shooting Shirt ($25)
___ BSA Sneaker Bag ($15) ___ BSA Duffel Bag ($25) ___ BSA "TEAM" Wristbands ($1)
____ Sunday Basketball Boot Camps - ____ Full Season or ____ # of sessions
____ BSA Academies - ___ Point Guard Academy ___ Shooting & Scoring Academy ___ Post Player Academy
For Academies - _____ Full Season or _____ # of sessions
____ BSA Elite Player Workout - ____ Full Season or ____ # of sessions: Times Preferred: ____________
____ Speed, Quickness & Basketball Strength Sessions - ____ Full Season or ____ # of sessions
____ Skill Development Mix & Match Special - _____ 5 for $150 _____ 10 for $250 _____ 20 for $400
____ Weeknight Basketball Leagues - ____ Hillcrest ____ Kiski - ____ Full Season or ____ # of sessions
____ Individual Instruction Workouts - _____ # of sessions - ____ 1 on 1 or ____ Group
____ Basketball Mini Camps - ___10/31 @ Hillcrest ___11/25@ Hillcrest ___12/26-29@Sewickley
                                                               ___1/16 @ Hillcrest
____ 2011 Spring AAU Tryouts - Pre-Registration (Only $40 if paid by 1/31/12)
Please mail completed registration form along with a check made out to: Basketball Stars of America LLCTo: Basketball Stars of America LLC, c/o Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108