The Big 60 Elite College Exposure Application- November 4
November 4, 2018
at Spooky Nook Sports
this is for individual players,
First Name ____________________________Last
Name ________________________________ Gender _______
City _______________________________ State ________ Zip code ___________
Print email address _______________________ Home phone ____________________ Birth date ____________
Height _______ Weight ______ Graduation year (circle one) ____2019 ____2020 ____2021 ____2022
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
______________ Boy's Elite Exposure Showcase Nov 4- registration- is $128.00 until Oct 20 and $140.00 late registration till Nov 4.
______________ Girl's Elite Exposure Showcase Nov 4- registration- is $128.00 until Oct 20 and $140.00 late registration till Nov 4.