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

          June 30 at Lancaster Bible College in Lancaster, PA
and August 11 at the Spooky Nook Sports Complex in Manheim, PA

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 4:30
-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


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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 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.



___________   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.
 

  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 -