2011 Basketball Stars Camps Basketball Day Camps Registration Form

Name: __________________________________________________________________

Date of Birth: __________ Grade (Entering next fall): __________ Graduation Year: _________

School: ________________________ School City & State: __________________________

Height: ________ Primary Position: ________ Jersey Size: ________ Sneaker Size: ________

Home Street Address: _______________________________________________________

City: _________________________________ State: ____________ Zip: ______________

Phone Numbers: ___________________________________________________________

Email: ___________________________________________________________________

Insurance Carrier: ___________________ Policy #: ________________________________

2011 Basketball Stars Camps Basketball Day Camps (Please check all attending):

___ Hempfield Day Camp 1: June 20th to 23rd
___ North Allegheny Day Camp 1: June 20th to 23rd
___ Kiski Day Camp 1: June 27th to 30th
___ North Allegheny Day Camp 2: June 27th to 30th
___ Robert Morris University Day Camp 1: July 5th to 8th
___ Hillcrest Day Camp 1: July 11th to 14th
___ Robert Morris University Day Camp 2: July 11th to 14th
___ Shady Side Academy 1: July 18th to 21st
___ Aquinas Academy 1: July 18th to 21st
___ Hillcrest Day Camp 2: July 25th to 28th
___ Aquinas Academy 2: August 1st to 4th
___ Aquinas Academy 3: August 8th to 11th
___ Hillcrest Day Camp 3: August 8th to 11th
___ Kiski Day Camp 2: August 8th to 11th
___ Hempfield Day Camp 2: August 15th to 18th
___ Shady Side Academy 2: August 15th to 18th

DISCOUNT CODE: _______________________________

Waiver: I understand that I am enrolling my child in the Basketball Stars Camps & Basketball Camps & Recruiting Showcases and that Basketball Stars Camps, BSA, 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 Basketball Stars Camps/BSA program. The applicant is in good health and able to participate in the physical activity of a vigorous program. The camp has my permission to provide emergency medical care in the event my son is injured or ill. I understand that Basketball Stars Camps/BSA retains the right to use, for publicity and advertising purposes, all photos and video of campers taken during camp.

Signature of Parent/Guardian:  _______________________________ Date: ____________
Please mail completed registration form along with a check made out to: Basketball Stars Camps Basketball To: Basketball Stars Camps Basketball, ATTN: Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108