2016-2017 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 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 or if a program is changed or cancelled, the player will receive a prorated credit towards another BSA or affiliated program. I also understand that photos and names of any player or team may be used in future promotional items.

Signature of Parent/Guardian: ______________________________________________________________    Date: ____________________

Programs: Please check all attending:

Choose Location:
___Sports & Courts North ___Southpointe Courthouse ___Monroeville Sports Center ___Cool Springs

Choose Programs:

____ Winter Weekend Skills Programs: ___ Full Season(s) or ___ # or Sessions
___Basketball Boot Camp
___Elite Skills Academy
___Jr NIT League (Sports & Courts Only)

____ Winter AAU Basketball Leagues: ___NIT ___NCAA ___NBA East
___NBA West ____ WNIT ___WNCAA ___WNBA East ___WNBA West
____ Uniform Fee (if needed - $100) or ____ Game Jersey ($35) - Size: ___________

____ Winter Weeknight Skills Programs: ___Weeknight Skills ___Advanced Weeknight Skills

____ Other Programs: ___Thanksgiving Monday Camp ____MLK Day Mini Camp

____Pre-Registration for Spring AAU Tryouts

Gear Options: ___BSA T-Shirt ($10) ___BSA Dry Fit T ($15) ___BSA Game Shorts ($35) ___BSA Shooting Shirt ($30) ___BSA Practice Jersey ($25)___BSA Sneaker Bag ($15) ___BSA "TEAM" Wristbands ($1) ___BSA Hoodie ($35) ___BSA Sweatpants ($35)

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