2021 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): __________________________________________________________________

Choose Your Program:
___ 2021 BSA Summer AAU Basketball Program 
___ 2021 BSA Summer In House Basketball Program
___ 2021 BSA Summer Weeknight Skills Basketball Program
___ 2021 BSA Summer Weeknight Skills Basketball Program
___ 2021 BSA Summer Basketball Camps

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

_____ East: Pittsburgh Sports Center in Fox Chapel Area

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 Basketball Camps:

Which Summer Basketball Camps are you registering for?

2021 BSA Summer Basketball Day Camps at Sports & Courts in Wexford, PA – 304 Warrendale Rd, Wexford, PA 15090: 
_____ Week 1: July 11th to 15th  
_____ Week 2: July 26th to 29th    
_____ Week 3: August 9th to 12th

2021 BSA Pittsburgh North Hills Summer Basketball Evening Camps at BSA Basketball Center in Wexford/Gibsonia, PA – 615B Warrendale Rd, Gibsonia, PA 15044:
_____ Week 1: June 28th to July 1st
_____ Week 2: August 23rd to 26th
_____ Week 3: August 30th to September 2nd

2021 BSA Summer Basketball Day Camps at Hillcrest Christian Academy – 2500 Bethel Church Rd, Bethel Park, PA 15102: 
_____ Week 1: July 12th to 15th
_____ Week 2: July 19th to 22nd
_____ Week 3: August 2nd to 5th
  
2021 BSA Summer Basketball Day Camps at Monroeville Sports Center – 855 Macbeth Drive, Monroeville, PA 15146: 
_____ Week 1: July 12th to 15th  
_____ Week 2: July 26th to 29th     
_____ Week 3: August 9th to 12th  

2021 BSA Summer Basketball Day Camps at Pittsburgh Sports Complex – 307 Coxcomb Hill Rd, New Kensington (Fox Chapel Area), PA 15068
_____ Week 1: July 19th to 22nd
_____ Week 2: August 2nd to 5th  

For All: 
BSA Gear Options: ____ BSA Adidas Uniform Set ($100) ____ BSA Adidas Game Jersey ($35)
____ BSA Adidas Game Shorts ($35) ____ BSA Dry Fit Shooting Shirt ($30) 
 ____ BSA Adidas T-Shirt ($15) ____ BSA Hoodie ($35) ____ BSA Sweatpants ($35) ____ 10 Packs of Sports Cards ($20)
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 Inc., c/o Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108