Elite Basketball Shootouts-2018
this is for individual players, not teams-
Players accepted on a first come basis.
First Name ____________________________Last
Name ________________________________ Gender _______
City _______________________________ State ________ Zip code ___________
Print email address _______________________ Home phone ____________________ Birth date ____________
Height _______ Weight ______ Graduation year (circle one) ___2018 ____2019 ____2020 ____2021 ____2022
High School ______________________________________ city__________________________________ state ______
Parent Consent and Medical
(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 _____________
: ____check ____ money order ____ credit card
on Pay Pal
___________ Boys Shootout,: Early registration for June 3- $128.00. Late registration after May 18, $140.00.
__________ Girls Shootout,: Early registration for June 3- $128.00. Late registration after May 18, $140.00.
Send your check or money order with your application (Make your check payable to: Bill Gaffey,) and send your completed application to Bill Gaffey 417 Bolton Drive, Harrisburg, PA 17112 -or pay by credit card on our Pay Pal (click on the BUY NOW button) -