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): ____________________________________________
Which Program are you Registering For?
___ AAU Tryouts
___ Spring In House Program
___ Spring Weeknight Skills Program
___ Late Winter/Early Spring AAU Pre-Season Skills Sessions
Which Practice Site do you prefer? (You may check off the one you want or rank them if more than one will work):
____ Pittsburgh North Hills: Sports & Courts North & North Allegheny Schools (Wexford)
____ Pittsburgh South Hills: Hillcrest Christian Academy (Bethel Park)
____ Pittsburgh South Hills: The Armory (Canonsburg)
____ Pittsburgh East: Monroeville Sports Center (Monroeville)
____ Pittsburgh East: Pittsburgh Indoor Sports Arena (Cheswick)
____ Pittsburgh East: Court Time Sports Center (Elizabeth)
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 Late Winter/Early Spring AAU Preseason
Skills Programs (Open Gyms/Skills Sessions), how many sessions?
Number of Sessions: ___ 1 ($45) ___ 3 ($100) ___ 5 ($175) ___ 8 ($200) ___ 10 ($250)
___ 20 ($400)
If Registering for Mini Camps:
____ Thanksgiving Monday (Dec 2)
____ MLK Day (Jan 20)
BSA Gear Options: ___BSA Practice Jersey ($25) ___BSA Adidas TShirt ($15)
___BSA Game Jersey ($35) ___BSA Game Shorts ($35)
___BSA Dry Fit Long Sleeve Shirt ($30) ___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 or Register by Phone at 412-400-1320 Online Registration is available at www.basketballstarsofamerica.com