Date of Birth
Payment Method (Cash/Check)
Please send prior to week of Oct. 22
Make Payments to:
312 McCully St.
Pittsburgh, PA 15216
I understand that I am enrolling my child in the Pittsburgh Basketball Report Showcase or affiliated
program, and that Pittsburgh Basketball Report LLC, Coach Steve Brodzinski, Coach Daryn Freedman,
The Kiskiminetas Springs School, 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!
Signature of Parent/Guardian: __________________________________ Date: _______________
Check The Box If You Agree To The Above Waiver:
Pittsburgh Basketball Report
Best of Pittsburgh Fall Showcase -
Saturday October 29th
Registration Form - *All required fields