Name: _____________________________________________________________________________
Date of Birth: ___________ Current Grade (as of March 2011): __________ Graduation Year: _________
School: _________________________________ School City & State____________________________
Home Street Address: __________________________________________________________________
City: ____________________________________________ State: __________ Zip: _________________
Phone Numbers: ______________________________________________________________________
Email: ______________________________________________________________________________
Insurance Carrier: ______________________ Policy #: ___________________________________
High School Players Only: Are you currently being recruited by any colleges? If yes, please list schools or level:
____________________________________________________________________________________
GPA: _____ ACT/(P)SAT Score: ______ College Basketball Level Interested In: __D1 __D2 __D3 __Other
2011 Basketball Stars Camps Spring Basketball Showcases (Please check all attending):
_____ Boys Spring High School Showcase at Kiski Prep School: March 19, 2011
_____ Boys Junior Elite Showcase at Kiski Prep School: March 19, 2011
_____ "The Beast" High School Boys All-American Camp at Slippery Rock University: July 5-8, 2011
_____ "The Beast" Boys Junior Elite Camp at Slippery Rock University: July 5-8, 2011
_____ Pittsburgh Summer Classic: July 8-10: ____ Individual Overnight ____ Individual Non-Overnight ____ Team
_____ Boys Summer High School Showcase at Kiski Prep School: July 13, 2011
_____ Basketball Stars Camps Boys Summer Junior Elite Showcase: July 13, 2011
_____ Basketball Stars Camps Super Session 1: June 27-30 at Kiski Prep School
_____ Basketball Stars Camps Super Session 2: July 17-20 at Slippery Rock University
_____ Basketball Stars Camps Super Session 3: August 3-6 at Slippery Rock University
_____ Basketball Stars Camps Specialty Session 1: June 30 to July 2 at Kiski Prep School
_____ Basketball Stars Camps Super Session 1: August 12-14 at Kiski Prep School
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
Online Registration is available at www.hoopmountainpa.com