"The Big 60 "-Elite College Exposure Application- November 6,  2016

Nov 6 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)  ____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 _____________


Payment choices (No Refunds) Check one:  ____check   ____ money order   ____ credit card on Pay Pal 

___________   For Nov 6-  $128.00  Boys Shootout,  early registration at Spooky Nook.   Late registration $140.00 Oct 26 until the event.
___________   For Nov 6-  $128.00  Girls Shootout,  early registration at Spooky Nook.   Late registration $140.00 Oct 26 until the event.

 


Send your check or money order with your application (Make your check payable to: Bill Gaffey,)   or pay by credit card on Pay Pal and send your completed application.

To pay  by credit card on Pay Pal, click on the button,  "Buy Now" (Make your payments payable to: Bill Gaffey, you don't need a Pay Pal account to make your payment)  Denote who the payment is for!!

Send your check or money order with your application (Make your check payable to: Bill Gaffey).  
For Pay Pal,
click on the "BUY NOW" button, then enter the amount you are paying in the "Price Per Item" box.


and mail to:  Bill Gaffey    417 Bolton Drive, Harrisburg, PA   17112
          
                            
call 717-545-0872------email wgaffey@pa.net


mail to:  bill gaffey
417 Bolton drive
harrisburg pa 17112