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,  early registration- at Spooky Nook Sports- late registration Oct 15  to day of the event $140.00.
___________   For November 5 - $128.00   Girls Shootout,  early registration- at Spooky Nook Sports late registration Oct 15   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 to Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112 -or pay by credit card on our Pay Pal(click on the BUY NOW button)

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