2008 Keystone State Basketball Shootout AT FRANKLIN & MARSHALL COLLEGE - LANCASTER, PA College Recruiting Profile/Application Please print this form, fill it out and mail with a Non-Refundable check or money order to: Keystone State Shootout, 7 Hemlock Road, Williamsport, PA 17701 | |||||||||
Last Name_______________________________________ First Name______________________________________Gender_____________ Address__________________________________________________ City__________________________ State________Zip_____________ Home Phone (__________)___________________________________ Cell Phone(____________)_________________________________ E-Mail Address _______________________________________________ School Name___________________________________________ Year of Graduation__________________ Age_________ Hgt_____________ Wgt__________ Shirt Size_________________(Adult Sizes) Head Basketball Coach____________________________________________Head Coach's Phone#(_______)_______________________ Your Class Rank_______________________ Number of Students in your Class___________ Grade Point Average_____________ Preferred College Major Course of Study_________________________________________________________________________________ S.A.T Scores: MATH ________ READING ________ WRITING ________ Total ________ ACT Total Score:___________ ATHLETIC INFORMATION - Answer for the Past Season Only - Be as accurate as possible Position you play:(max 2) ___ 1-Point Guard ___ 2-Shooting Guard ___ 3-Small Forward ___ 4-Strong Forward ___ 5-Center FG%__________________ FT%__________________ 3PT%__________________ Assists Per Game___________________ Points per Game______________ Career Points_____________ Rebounds per Game_____________ Steals per Game_____________ AAU Coach's Name _______________________________________ AAU Coach's Phone# (______)__________________________________ Coach's Email Address: _________________________________________________________________________________________________ Camp(s) attended last summer: Individual_____________________________________ Team___________________________________ Top 5 College Choices:__________________________________________________________________________________________________ Parental Consent & Medical Information Form (Participant cannot compete unless this section has been completed & signed by his/her parent or guardian) If you do not have medical insurance you MUST CALL Keystone for an insurance waiver. I understand that Franklin & Marshall College and Keystone State Camps, Ltd. do not carry medical or accident insurance for students, and I hereby certify that my child is covered by a personal insurance policy or is included in a policy which I have in force. Further, I hereby authorize routine medical dispensary care for my child and any treatment not considered routine to be referred to a local physician at my expense. Insurance Co.__________________________________Policy #_____________________________Group #______________________________ _________________________________________________________________________________________________________________________ Name of Policy Holder Signature of Parent/Guardian Must be signed!! Date Send this Profile/Application and the non-refundable $120 fee payable to: Keystone State Shootout, 7 Hemlock Road, Williamsport, PA 17701 Telephone (570) 323-2072 Fax (570) 323-8735 | |||||||||
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