May 21, 2017-Elite College Exposure Application-The Big 60

           May 21 at Lancaster Bible College 
(901 Eden Rd, Lancaster, PA 17601

Players in grades  9, 10, 11. and 12 are eligible to participate. 
Players will be accepted on a first come basis.

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

-Check the schedule two days before the event on www.pahoops.org
 

First Name ____________________________Last Name ________________________________ Gender  _______

Address _______________________________________

City _______________________________              State ________        Zip code   ___________

Print email address  _______________________   Home phone ____________________    Birth date ____________

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 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 _____________


Payment choices       Check one: :           ____check           ____ money order         ____ credit card on Pay Pal 

__________

___________   For May 21- $128.00  Boys Shootout,  early registration- at Lancaster Bible College- late registration May 6  to day of the event $140.00.
___________   For May 21   $128.00   Girls Shootout,  early registration- at Lancaster Bible College-late registration May 6   to day of the event $140.00.
  
 

 Send your check or money order with your application (Make your check payable to: Bill Gaffey,)  and send your completed application.  
--  or pay by credit card on Pay Pal

To pay  by credit card on Pay Pal, click on the button,  "Buy Now" (Make your payments payable to: Bill Gaffey, you don't need a Pay Pal account to make your payment)  Denote who the payment is for!!

 

 No refunds during last week of the event and mail to:  Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112--  call 717-545-0872------email wgaffey@pa.net