2017 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): __________________________________________________________________

Which Day Camps are you registering for?

Summer Day Camps at Sports & Courts in Wexford, PA – 304 Warrendale Rd, Wexford, PA 15090:
_____ Week 1: July 17th to 20th - DeJuan Blair Pro Camp Week 
_____ Week 2: July 24th to 27th 
_____ Week 3: August 7th to 10th  
_____ Week 4: August 14th to 17th

Summer Day Camps at Southpointe Courthouse – 281 Georgetown Rd, Canonsburg, PA 15317:
_____ Week 1: June 26th to 29th
_____ Week 2: July 10th to 13th
_____ Week 3: July 24th to 27th - DeJuan Blair Pro Camp Week 
_____ Week 4: August 7th to 10th  

Summer Day Camps at Monroeville Sports Center – 855 MacBeth Drive, Monroeville, PA 15146:
_____ Week 1: June 19th to 22nd
_____ Week 2: July 10th to 13th 
_____ Week 3: July 31st to August 3rd        

Summer Basketball Day Camps at Pittsburgh Indoor Sports Arena – 22 Rich Hill Rd, Cheswick, PA 15024:
_____ Week 1: August 14th to 17th

Discount Code (If applicable): _________________

Waiver: I understand that I am enrolling my child in the Basketball Stars of America 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 also understand that there are no refunds for the Tryout Fee or Tuition Fee! If a player is injured and can’t continue, he or she will receive a prorated credit towards another 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 LLC, c/o Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108