2023 Basketball Stars of America Fall Programs Registration Form:

Name: ______________________________________________________ Date of Birth: _____________________
Age: _________  Grade: _________ School: ________________________________________________________
Height: ____________      Primary Position: ___________     Uniform Size: ____________   Sex: Male/Female
Home Street Address: ___________________________________________________________________________
City: _______________________________________________ State: ____________ Zip: ____________________
Phone Numbers: _______________________________________________________________________________
Email: _______________________________________________________________________________________
Discount Code: ____________________________________
Teammate, Coach or Number Requests: ___________________________________________________________
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, he or she will receive a prorated credit towards another BSA or affiliated program. I also understand that my child’s picture or team picture may be used in future BSA advertising material.

Signature of Parent/Guardian:  ____________________________________________  Date: ___________
Programs: Please check all attending:
Choose The Program You Are Registering For:
____ 2023 Fall AAU Basketball Program
____ 2023 Fall In House Basketball Program
____ 2023 Fall Weeknight Basketball Skills Program
____ 2023 Fall Weekend Basketball Skills Program – Choose Skills Program Below
____ 2023 Fall Basketball Mini Camps – Choose Camp Below
If choosing AAU, In House or Skills, do you want to add an extra night of skills per week for $100 - ___Yes ___No
Choose The Practice Location You Prefer:
____ Pittsburgh North Hills: BSA Basketball Center 
____ Pittsburgh North Hills: Sports and Courts North in Wexford/Gibsonia, PA
____ Pittsburgh South Hills: The Armory in Canonsburg, PA
____ Pittsburgh South Hills: Hillcrest Christian Academy in Bethel Park, PA
____ Pittsburgh East: Monroeville: All-American Fieldhouse in Monroeville, PA
____ Pittsburgh West: Robinson Twp Recreation Center in Robinson Twp, PA
If Choosing Weekend Basketball Skills, Choose Your Skills Programs:
____ Basketball Boot Camp ____ BSA Point Guard & Shooting Academy ____ Elite Shooting & Scoring Academy
If Choosing Weeknight Skills or In House, Choose Your Weeknight Skills Programs:
____ Basic Basketball Skills  or ____ Advanced Basketball Skills
If Choosing Basketball Mini Camps, Choose Your Camps:
____Thanksgiving Monday – Monday, November 27th at Monroeville Sports Center
____MLK Day – Monday, January 15th at Monroeville Sports Center
BSA Gear Options (Check all Ordering):
____ BSA Adidas Game Uniform Set ($100) – Includes Game Jersey, Game Shorts & Shooting Shirt – Size: _____
____ BSA Adidas Game Jersey ($35) – Size: _____
____ BSA Adidas Game Shorts ($35) – Size: _____
____ BSA Shooting Shirt ($30) – Size: _____
____ BSA T-Shirt ($15) – Size: _____
____ BSA Hoodie ($35) – Size: _____
____ BSA Sweatpants ($35) – Size: _____
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
Register by Phone at 412-400-1320