November 5,  2017-Elite College Exposure Application-The Big 60

         November 5 at Spooky Nook Sports
GPS Address: 75 Champ Blvd. | Manheim, PA 17545
Mailing Address: 2913 Spooky Nook Rd. | Manheim, PA 17545


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)     ___2018   ____2019 ____2020    ____2021 

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 November 5- $128.00  Boys Shootout, 
___________   For November 5 - $128.00   Girls Shootout,     
 

  Send your check or money order (payable to: Bill Gaffey)  with your application and mail your completed application to 
Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112

 -or pay by credit card on our Pay Pal Account -click on the Buy Now button 
1-If you do not have a Pay Pal account, then after you click on BUY NOW scroll down to "Pay with Debit or Credit Card" which is below the LOG IN and complete your payment on the Guest Checkout area.
2-If you have Pay Pal account then use it to complete your payment.
Please print the player's name in the box below

Player's Name

For more information or help-call 717-545-0872 -email wgaffey@pa.net -No refunds during week prior to the event-

or go to our website at www.pahoops.org