The Big 60 Elite College Exposure Application- November 4

November 4, 2018

 at Spooky Nook Sports 
2913 Spooky Nook Rd. | Manheim, PA 17545
Players in grades  9, 10, 11. and 12 are eligible to participate. 
Players will be accepted on a first come basis.

this is for individual players, not teams-
All games live streamed & placed on YOUtube-
Go to our website at www.pahoops.org two days before the event  to find your game times.    Division 1, 2, and 3  coaches can all watch you play in this event!

First Name ____________________________Last Name ________________________________ Gender  _______

Address _______________________________________

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 Pay Pal 

______________
 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. 
 

  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

 -or pay by credit card on our Pay Pal Account -click on the Buy Now button 
1-You do not have to have a Pay Pal account,  scroll down to 'Pay with Debit or Credit Card" and complete your payment.
2-If you have Pay Pal account then use it to complete your payment.

3-Or, send your check or money order with your completed application (Make your check payable to: Bill Gaffey,)  and send to Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112 -or pay by credit card on our Pay Pal
(click on the BUY NOW button) -

Player's Name

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