The Big 60 -"Cream of the Crop"-Elite College Exposure Application-
 November 6, 2016
  at Spooky Nook Sports (Manheim, PA)  17545

Boys-Registration and Girls-Registration
-
You only need to arrive a half hour before your first game
-Check the posted schedule two days before the event on http://www.pahoops.org/

  -separate  divisions: one for boys and one for girls-Players in grades  9, 10, 11. and 12 are eligible to participate.

  Mail your form in early.    Players will be accepted on a first come basis.

this is for individual players, not teams-
All three games live streamed
& all three games placed on YOUtube

First Name ____________________________Last Name ________________________________ Gender  _______

Address _______________________________________                                                     Birth date ____________

City _______________________________              State ________        Zip code   ___________

Print email address  _______________________   Home phone ____________________   

Height _______  Weight ______Graduation year (circle one)  ____2017   ___2018   ____2019____2020

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 not 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 this event.

Insurance Company ____________________ Policy _____________ Group # ________

Name of Policy Holder _____________________________ Home Phone __________

Signature of parent/guardian _________________________ Cell phone _____________


___________   For Nov 6-  $128.00  Boys Shootout,  early registration at Spooky Nook.   Late registration $140.00 Oct 26  until the event.
___________   For Nov 6-  $128.00  Girls Shootout,  early registration at Spooky Nook.   Late registration $140.00 Oct 26 until the event.

Payment choices   Check one:     check ____,  money order  ____ ,   Pay Pal_____           (No Refunds in the week prior to the event)

Send your check or money order with your application (Make your check payable to: Bill Gaffey).  
For Pay Pal,
click on the "BUY NOW" button, then enter the amount you are paying in the "Price Per Item" box.


and mail to:  Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112
          
                            
call 717-545-0872------email wgaffey@pa.net