2017 Basketball Stars of America AAU Tryouts & In House Programs Registration Form


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)

____Sports & Courts North (Wexford)
____ Southpointe Courthouse (Canonsburg) ____ Cool Springs Sports Complex (Bethel Park)
____Gateway High School (Monroeville) ____ Pittsburgh Indoor Sports Arena (Fox Chapel Area)

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 ($500)

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
Online Registration is available at www.basketballstarsofamerica.com