Elite Basketball Shootouts-2023                          Print off this application

College Exposure Application-                     Then fill it out and mail it

(please print clearly)

First Name _______________________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
 this event.
Insurance Company ____________________ Policy _____________ Group # ________

Name of Policy Holder _____________________________ Home Phone __________

Signature of parent/guardian _________________________ Cell phone _____________

Payment choices : ____ check,  ____ money order
 print this application and mail  it.    Make your check or money order payable to Bill Gaffey.

______ Friday   June 9-    -Early registration $138.00 before 5/23/23 or $148 later.

______ Sunday August 13-Early registration $138.00 before 7/28//23 or $148 later.

______Sunday October 29-Early registration $138.00 before 10/10/23 or $148 later.
 

Mail to-   Bill Gaffey,  417 Bolton Drive,  Harrisburg  PA   17112

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