Basketball Showcase: Game Package | Georgia Athletic Coaches Association

DETAILS

Congratulations on the All-Star selection of your player. Please complete this form and submit ASAP.

All forms must be submitted online, but you can click on the following link to print out a blank copy: Basketball Showcase Form. This can be given to and signed by the parent.

MEDICAL / PHYSICAL

Please upload your child's physical here. It is required This can be done by scanning the physical to your computer and uploading here.

A parent can take a picture of their child's physical and upload it below...either from their computer or phone.

Player Physical*

Please upload your child's physical here. It is required This can be done by scanning the physical to your computer and uploading here.

PLAYER INFORMATION

Player Name*

First Last

Email*

Gender*

Grade*

Date of Birth*

Place of Birth*

High School*

Coach's Name*

First Last

Coach's Email*

Coach's Cell Phone*

Weight*

Height*

Shoe Size*

Shirt Size*

Pant Size*

Dominant Hand*

Address*

This is the address where your picture will be sent.

Street Address City State ZIP Code

Will you be on scholarship for college?*

Please give us the name of college/university*

Will you attend college if you do not have a scholarship?*

Where will you attend?*

List all high school sport honors*

350 character max

List all academic organizations that you belong to:*

350 character max

Please describe the most memorable sporting event that you were involved in:*

350 character max

Do you have asthma or allergies?*

Please explain*

Do you have diabetes?*

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name*

First Last

Email*

Parent/Guardian #2 Name

First Last

Home Phone*

Cell Phone*

Night-Time Phone*

Are you covered by insurance?*

Insurance Company*

Group Number*

Policy Number or Branch of Service*

Is your child allergic to any medicine?*

Please list*

Is your child taking any medications?*

Please list*

Please list any serious injuries, illness or circumstances we should be aware of before administering care:*

Enter N/A is this does not apply to you

EMERGENCY CONTACT

Every attempt will be made to contact you in case of injury. Should this not be possible or practical, please list the name of a relative who can authorize treatment.

Name*

First Last

Relation*

Phone*

SIGNATURES/ATTESTATIONS

Player Attestation*

I hereby accept the Georgia Athletic Coaches Association's invitation to play in the North-South All-Star Basketball Showcase being held at Dalton High School, Dalton, GA. I agree to abide by the rules and disciplines set forth by the officials of the Georgia Athletic Coaches Association. I understand that I am to report to the North-South All-Star Basket all Game on the dates listed above.

Parent Attestation*

Please check all:

I verify that the above information to b true and accurate to the best of my knowledge.
I do hereby approve emergency treatment, as deemed necessary, by the hospital and/or medical staff (physician, athletic trainer)on site for my son/daughter listed above.
I give this consent with full knowledge and assumption on my part for any and all financial responsibilities incurred as a result of participation in the All-Star Basketball game and practices. My insurance company will serve as the primary coverage for my child. The Georgia Athletic Coaches Association's insurance will be secondary insurance.
I hereby give my consent for the student named above to engage in approved sports activities, related to the North-South Basketball All-Star camp and Game. It is my clear understanding that participation in athletics activities (e.g. football, basketball, baseball and softball) creates a risk normally associated with such activity. I agree not to hold the Georgia Athletic Coaches Association or anyone acting on its behalf responsible for any injury occurring to my son/daughter in the proper course of such athletic activities or travel. I further give my permission for the appropriate all-star association staff members or their designees (physicians, athletic trainers, student trainers, coaches) to render emergency treatment or authorize medical treatment by a hospital and/or physician or medical staff.

Player Signature*

Parent/Guardian Signature*

Payment

If paying online, please click the submit button once. You will be directed to PayPal for payment.

If paying by mail, please mail check to:

GACA
PO BOX 597
ELBERTON, GA 30635

Submission of form without payment does not qualify your athlete for the All-Star game. Payment must be collected in order for your athlete to participate in the All-Star game.

How will you be paying?*

All-Star Cost*

Price: $300.00

Processing Fee*

Price: $15.00

Total

$0.00

All-Star Basketball Showcase Package

DETAILS

MEDICAL / PHYSICAL

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT

SIGNATURES/ATTESTATIONS

Payment