The Big 60 - 2019 Top 100 Elite College Exposure Application-The Big 60
First Name ____________________________Last
Name ________________________________ Gender _______
City _______________________________ State ________ Zip
Print email address __________________________________ Home phone _____________
-This is for individual
players, not teams
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 August 11- $128.00 Boys Shootout, early registration up to July 28 at Spooky Nook- late registration after July 28 to day of the event $140.00.
___________ For August 11 - $128.00 Girls Shootout, early registration up to July 28 at Spooky Nook- late registration after July 28 to day of the event $140.00.
___________ For November 3- $128.00 Boys Shootout, early registration up to October 16 at Spooky Nook- late registration after October 16 to day of the event $140.00.
___________ For November 3 - $128.00 Girls Shootout, early registration up to October 16 at Spooky Nook- late registration after October 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.