The Big 60 - 2019  Top 100 Elite College Exposure Application-The Big 60

          at Lancaster Bible College
901 Eden Road, Lancaster, PA 17601

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

First Name ____________________________Last Name ________________________________ Gender  _______


Address _____________________________________________Birth date ____________
 

City _______________________________              State ________        Zip code   ___________
 

Print email address  __________________________________ Home phone _____________

-This is for individual players, not teams
-You play in 3 games, -equal playing time
-Your 3 games are live streamed & placed on YOUtube
-This is a one day event, 8:30 to 3:30
-Friday before the Showcase go to our website
www.pahoops.org  to see what time you play
-You only have to arrive a half hour before your first game to sign in and pick up your game shirt


-
 

Height _______  Weight ______                                 Graduation year (check one)     ___2019   ____2020 ____2021    ____2022 ____2023

High School ______________________________________      _ 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 March 24- $128.00  Boys Shootout,  early registration up to March 9- at Lancaster Bible College- late registration March 10  to day of the event $140.00.
___________   For March 24 - $128.00   
Girls Shootout,    early registration up to March 9- at Lancaster Bible College- late registration March 10  to day of the event $140.00.


___________  For June30- $128.00  Boys Shootout,  early registration up to June 15- at Lancaster Bible College- late registration June 16  to day of the event $140.00.
___________  For June 30 - $128.00   Girls Shootout,    early registration up to June 15- at Lancaster Bible College- late registration June 16  to day of the event $140.00.

 

  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

 -To pay by credit card on our Pay Pal Account 
1-Type in the name of the player in the "Player's Name" box
2-Click on the 
Buy Now Button  
3-If you do not have a Pay Pal account, then scroll down to "Pay with Debit or Credit Card" and complete your payment.
4-If you have a Pay Pal account then use it to complete your payment.

Player's Name

For more information or help-call 717-545-0872 -email wgaffey@pa.net -