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basketball shootouts by
HOOPS
this is for
individual players, not teams |
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1-the
Elite College Exposure Shootout, Sunday October 10, 2010
-for boys and girls
Penn State-Harrisburg University-777
West Harrisburg Pike · Middletown, PA 17057
-Hotels for the Penn State Shootout
HERE
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for boys and girls
Players have attended from West Virginia, Virginia,
Delaware,
D. C., Maryland, Ohio, New York,
North Carolina,
Michigan, New Jersey, Pennsylvania, Massachusetts,
Connecticut, New Hampshire, Michigan and Canada. |
Print this form, fill it out, and
mail it.
Name
Address
City State Zip code
Email address
Home phone
Height
Weight
Birth date
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Graduating year (circle one) 2011, 2012,
2 013, 2014
High School
City
State ZIP
High
Coaches Name _______________________________
Any other
Coach _______________________________
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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 Shootout and the host school do not carry medical
or accident insurance for the participants, and I here by 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 _____________
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Early registration:
$115.00
to
Sept 24, 2010
Late registration:$130.00
from Sept 25 to the event
Schedule
Boys: Register 8:00-8:30
first boy's games 8:30 am
Girls: Register 11:00-11:30
first girl's games 12:15
You can print off this application, fill it out and send it with your check, or
if you want, send your name and address and we will mail you an application.
call 717-545-0872------email
pahoops@verizon.net
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If you are attending the
Pennsylvania Shootout Print
this form, fill it out, and mail it.
Players in grades 9, 10, 11. and 12 are eligible to participate.
Check one:
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$115.00 Boys Shootout, early registration
____________ $115.00 Girls Shootout, early registration,
___________ $130 Late registration fee, Boys
___________ $130 Late registration fee,
No refunds
Make your check payable to: Bill Gaffey
and mail to: Basketball Shootouts,
c/o Bill Gaffey
417 Bolton Drive, Harrisburg, PA 17112
call 717-545-0872------email
pahoops@verizon.net |
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