2012-13 Basketball Stars of America Winter Programs 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
Winter AAU Basketball Leagues @ Sewickley Academy:
___JR NIT ___NIT ___NCAA ___NBA East ___NBA West
___ WNCAA ___WNBA East ___WNBA West
Winter Weekend Basketball Programs:
____ Sunday Basketball Boot Camps - ____ Full Season ($325) or ____ # of sessions ($35/each)
____ BSA Academies: ___ Point Guard Academy ___ Shooting & Scoring Academy ___ Post Player Academy
For Academies: _____ Full Season ($325) or _____ # of sessions ($35/each)
____ BSA Elite Basketball Prospect Workouts - ____ Full Season ($325) or ____ # of sessions ($35/each)
____ BSA AAU Elite Workouts - ___ Full Season ($200) or ____ # of sessions ($35/each)
____ BSA Weekend 1 on 1 Workouts - ___ 10 Sessions ($500) or ____ # of sessions ($60/each)
Winter Weeknight Basketball Programs:
____ BSA Weeknight Basketball Programs @ Hillcrest Christian Academy (Bethel Park, PA):
___Boys NCAA ___Boys NBA East ___Girls WNCAA ___Girls WNBA
____ BSA Weeknight Basketball Programs @ Kiski Prep School (Saltsburg, PA):
___Boys NCAA ___Boys NBA East ___Girls WNCAA ___Girls WNBA
Winter Camps:
____ MLK Day Camp - January 21st @ Hillcrest ($75)
____ MLK Day Camp - January 21st @ Aquinas Academy - Gibsonia ($75)           
BSA Gear Options (Check all Ordering):
____ BSA Jersey ($25) Size: ______
____ BSA Shorts ($25) Size: ______
____ BSA Shooting Shirt ($25) Size: _____
____ BSA Duffel Bag ($25)
____ BSA Sneaker Bag ($15)