By Big 60 :  June  19,  2016- Girl’s  Elite Basketball Spotlight I   -Application  _______
                     June  19,  2016- Boy’s College Spotlight 100  I                 -
Application  _______

June 19 at Spooky Nook Sports (Manheim, PA)
-separate  divisions: one for boys and one for girls

Players in grades  9, 10, 11. and 12 are eligible to participate.  Mail your form in early.   
 Players will be accepted on a first come basis.

this is for individual players, not teams-
All games live streamed
& all games placed on YOUtube


Boys-Registration or Girls-Registration
-Check the posted schedule two days before the event on http://www.pahoops.org/
-Arrive at least a half hour before your first game

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 Pay Pal 
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