Name: ___________________________ Date of Birth: _____
Age: ______ Grade: ______ 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): ____________________________________________
Which Program are you Registering For?
___ Pre-Pay for 2022 Spring AAU Season - ___Add New Uniform or ___Have Uniform
___ 2022 Spring AAU Tryouts
___ 2022 Spring In House Program
___ 2022 Spring Weeknight Skills Program: ___Weeknight Skills or ___Advanced Skills
___ 2022 Spring Weekend Skills Program: ___Starter Program or ___Basketball Boot Camp or ___Elite Shooting & Scoring Academy
___ 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 (Wexford) & BSA Center (Gibsonia)
____ Pittsburgh South Hills: Shoot 360 Pittsburgh (Bethel Park) & The Armory (Canonsburg)
____ Pittsburgh East: Monroeville Sports Center (Monroeville)
Do you have any Teammate or Coach Requests?
____________________________________ (These are not guaranteed!)
Do you have any uniform # requests? __________________ (Not guaranteed)
If you already have an Adidas BSA Uniform that you will use, what is the jersey number? _____
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 ($125) ___ 5 ($200) ___ 10 ($300)
___ 20 ($400)
BSA Gear Options: ___BSA Uniform ($100) ___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) ___10 Packs of Sports Cards ($20)
Waiver: I understand that I am enrolling my child in the Basketball
Stars of America AAU Program and that the Basketball Stars of America Inc., 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. If a Program is Postponed due to any reason, the player will receive a credit for any time that was missed. 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 Inc. To: Basketball Stars of America Inc., 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