2023 Basketball Stars of America Late 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 ___BSA Basketball Center ___Hillcrest Christian Academy
___The Canonsburg Armory ___All-American Fieldhouse ___Monroeville Sports Center

Choose Programs:
____ Winter AAU Program
____ Winter In House Program
____ Winter Weeknight Skills Program – Day/Time: ____________________________
____ Winter Weekend Skills: ___ Starter Program / ___ Boot Camp / ___ Elite Shooting & Scoring
____ Mini Camps: ___MLK Day Mini Camp
____ Add 1 or 2 Weekend or Weeknight Skills Programs for $100 each

Gear Options: ___ BSA Adidas Uniform ($100) ___ BSA Adidas Game Jersey ($35) ___BSA Adidas Game Shorts ($35) ___BSA Adidas Shooting Shirt ($30) ___BSA Hoodie ($35) ___BSA Sweatpants ($35) ___BSA Adidas T-Shirt ($15) ___10 Packs of Sports Cards ($20)

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

Online Registration is available at www.basketballstarsofamerica.com