**2017 Upstate Throwdown College Exposure Shoot-out Registration Form**

Boys Event on October 1st, 2017 T-SHIRT SIZE ________

Name: __________________________ Home phone: ____________________

Cell phone: ___________________

Address:

____________________________________________________________________________________

______

Email: _______________________________________ Grade: _____ Height: ______ School: ___________________

Varsity Coach: ______________________________ Phone: ______________

Email: __________________________

Last Year’s Varsity Stats: PPG: ________ Rebounds per game: ________ Assists per game: ____________________

Academic Info: GPA: ________ SAT: _______ ACT: _________

MEDICAL INFORMATION (PARTICIPANTS MUST HAVE MEDICAL INSURANCE) Insurance Company:

______________________________________________________________

Group #: ________________ Policy #: __________________

Special Medical Conditions:

__________________________________________________________________________

IN CASE OF EMERGENCY
Name: ____________________________

Phone Number ______________________________________________

UPON PAYMENT, it is understood that any player who does not abide by the rules set for by Upstate Scouting Service’s College Exposure Shoot-Out 2017 staff is subject to dismissal without reimbursement. I am also aware that participants in the event MUST have medical insurance.

In case of emergency, I will authorize the staff of Upstate Scouting Service’s College Exposure Shoot-Out 2017 to act in their best judgment in the event I cannot be reached. I will not hold the staff of the event or Upstate Scouting Service, or the event site liable for any injury or illness during the participation of Upstate Scouting Service’s College Exposure Shoot-Out 2017.

Parent or Guardian Name: ____________________________________________________

Date: ______________________