Elite Basketball Shootouts-2023
College Exposure Application-
(please print clearly)
_______________________Last Name _____________________________ Gender ____
Address_________________________________ City ________________________ State ________
Zip code ___________ Telephone ____ _____ _______
Email address _________________________________________ Height _______ Weight ______
Graduation year (circle one) ___2023 __ 2024 ___2025 ___2026___2027
High School _______________________________ city________________________ state ______
Parent Consent and Medical Information (Players cannot participate unless they have medical insurance).-
Players cannot participate
unless this section has been completed and signed by the parent or guardian.
I understand that the Showcase and the host venue does not carry medical or accident insurance for the
participants, and I hereby certify that my child is covered by personal insurance or is included in a policy
which I have in place. I authorize routine medical care for my child by the Shootout trainer. I further
authorize any treatment considered routine to be referred to a local physician or to an emergency room
at my expense. I further authorize and provide my consent and permission for my child to participate in
Insurance Company ____________________ Policy _____________ Group # ________
Name of Policy Holder _____________________________ Home Phone __________
Signature of parent/guardian _________________________ Cell phone _____________
Payment choices. Check one:
____ check, ____ money order, ____ credit card (Go to our webpage-
www.pahoops.org and click on the BUY NOW BUTTON to make your credit card payment).
If you pay by check or money order, print this application and send it. Make your check or money order
payable to Bill Gaffey.
June 9- -Early registration $138.00 before 5/23/23 or $148
______ Sunday August 13-Early registration $138.00 before 7/28//23 or $148 later.
______Sunday October29-Early registration $138.00 before 10/10/23 or $148 later.
Mail to Bill Gaffey, 417 Bolton Drive, Harrisburg PA 17112
or scan and email to firstname.lastname@example.org
Our website: www.pahoops.org Follow us on Twitter at @Pa_Big60