Big 60 : June
Spotlight I -Application
June 19, 2016- Boy’s College Spotlight 100 I -Application _______
at Spooky Nook Sports
is for individual players, not teams-
First Name ____________________________Last
Name ________________________________ Gender
Address _______________________________________ Birth date ____________
City _______________________________ State ________ Zip code ___________
Print email address _______________________ Home phone ____________________
Height _______ Weight ______Graduation year (circle one) ____2016 ____2017 ___2018 ____2019____2020
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 not 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 _____________
___________ For June 19- $128.00
Boy's College Spotlight, early
registration. Late registration $140.00 June 5 until the event.
___________ For June 19- $128.00 Girls Elite Spotlight early registration. Late registration $140.00 June 5 until the event.
Payment choices (No
Refunds in the week prior to the event) Check one:
____check ____ money order ____ credit card on
Send your check or money order with your application (Make your check payable to: Bill Gaffey,)
or pay with your credit card on Pay Pal (you don't need a Pay Pal account to make your payment) and mail your completed application.
-To pay by credit card on Pay Pal, click on the "x" in the box next to Pay Pal
- make the Item Price 128.00
mail to: bill gaffey
417 Bolton drive
harrisburg pa 17112