2019 Basketball Stars of America AAU Summer Programs & Camps Registration Form:

Name: ______________________________________ Date of Birth: ______________
Age: ________ Grade entering: ________ School: __________________________________
Height: ______ Primary Position: ______ Uniform Size: ______ Sneaker Size: ______ Gender: Male/Female
Home Street Address: _______________________________________________________
City: ____________________________________ State: ________ Zip: ___________
Cell Phone Numbers: _________________________________________________________
Home/Work Phone Numbers: __________________________________________________
Email (s): __________________________________________________________________

If Registering for Summer AAU Program, In House Program or Weeknight Skills Program: 
Choose Your Program:
___ 2019 BSA Summer AAU Basketball Program 
___ 2019 BSA Summer In House Basketball Program
___ 2019 BSA Summer Weeknight Skills Basketball Program

Choose Your Practice Site: (You May Check 1 off or rank them in order):
_____ North Hills: Sports & Courts in Wexford or North Allegheny School
_____ South Hills: The Armory in Canonsburg
_____ South Hills: Hillcrest Christian Academy in Bethel Park
_____ East: Monroeville Sports Center in Monroeville

_____ East: Pittsburgh Indoor Sports Arena in Cheswick
_____ BSA Court Time: Court Time Sports Center

Do you need a New BSA Adidas Uniform ($100) – Yes ___ or No ___ - If yes, what size? ______ (YS to A2XL available)

Do you have any Teammate or Coach Requests? _______________________________
(These are not guaranteed!)

Do you want to add an extra Night of Skills Practice per week ($100 for AAU Players) – Yes ___ or No ____

If Registering for Summer Day Camps:

Which Day Camps are you registering for?

2019 BSA Summer Basketball Day Camps at Sports & Courts in Wexford, PA – 304 Warrendale Rd, Wexford, PA 15090: 
_____ Week 1: July 15th to 18th  
_____ Week 2: August 5th to 8th

2018 BSA Summer Basketball Day Camps at Hillcrest Christian Academy – 2500 Bethel Church Rd, Bethel Park, PA 15102: 
_____ Week 1: June 24th to 27th  
_____ Week 2: July 15th to 18th  
_____ Week 3: July 29th to August 1st  
_____ Week 4: August 5th to 8th
BSA Summer Basketball Day Camps at Monroeville Sports Center – 855 Macbeth Drive, Monroeville, PA 15146: 
_____ Week 1: June 17th to 20th  
_____ Week 2: June 24th to 27th   
_____ Week 3: July 22nd to 25th  
_____ Week 4: August 12th to 15th  

BSA Summer Basketball Day Camps at Printscape Arena in Canonsburg – 114 Southpointe Blvd, Canonsburg, PA 15317
_____ Week 1: July 22nd to 25th
_____ Week 2: August 12th to 15th

For All: 
BSA Gear Options: ____ BSA Adidas Uniform Set ($100) ____ BSA Adidas Team Sneakers ($90)
____ BSA Adidas Game Jersey ($35) ____ BSA Adidas Game Shorts ($35)
____ BSA Adidas Shooting Shirt ($30) ____ BSA Practice Jersey ($25)
____ BSA Adidas T-Shirt ($15) ____ BSA (Non-Adidas) T-Shirt ($10) ____ BSA Adidas Hoodie ($50) ____ BSA Adidas Sweatpants ($50) ____ BSA Adidas Backpack ____ BSA Adidas Travel Suit
Discount Code (If applicable): _________________
Waiver: I understand that I am enrolling my child in the Basketball Stars of America AAU Program and that the Basketball Stars of America, Coach Daryn Freedman or any facilities that are used or any coaches will not be liable for any injuries incurred during participation in the program. I understand that my child’s photo and likeness may be used in promotional campaigns and filmed by BallerTV. I also understand that there are No Refunds of any fees paid! If a player is injured and can’t continue, he or she will receive a prorated credit towards a future BSA program.

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