Big 60 "-
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) ____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 email@example.com
mail to: bill gaffey
417 Bolton drive
harrisburg pa 17112