All-Star Basketball Showcase Package DETAILSCongratulations 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. The games will be played on March 14, 2020 at Dalton High School, 1500 Manly Street, Dalton, GA 30720. GIRLS REPORT TO:LaQuinta Inn and Suites, 715 College Dr, Dalton, GA 30720, 706-272-9099 at 2pm on 3/13/20 BOYS REPORT TO:Comfort Inn and Suites, 905 West Bridges Road, Dalton, GA 30720, 706-259-2583 at 2pm on 3/13/20MEDICAL / PHYSICALPlease 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.Max. file size: 12 MB.PLAYER INFORMATIONPlayer Name* First Last Email* Gender*Select GenderGirlBoyGrade*Select YearSeniorJuniorDate of Birth* MM slash DD slash YYYY 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*Select OneRight HandLeft HandAddress*This is the address where your picture will be sent. Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Will you be on scholarship for college?*Select OneYesNoNot known yetPlease give us the name of college/university* Will you attend college if you do not have a scholarship?*Select OneYesNoWhere will you attend?* List all high school sport honors*350 character maxList all academic organizations that you belong to:*350 character maxPlease describe the most memorable sporting event that you were involved in:*350 character maxDo you have asthma or allergies?*Select OneYesNoPlease explain* Do you have diabetes?*Select OneYesNoPARENT/GUARDIAN INFORMATIONParent/Guardian Name* First Last Email* Parent/Guardian #2 Name First Last Home Phone*Cell Phone*Night-Time Phone*Are you covered by insurance?*Select OneYesNoInsurance Company* Group Number* Policy Number or Branch of Service* Is your child allergic to any medicine?*Select OneYesNoPlease list* Is your child taking any medications?*Select OneYesNoPlease 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 youEMERGENCY CONTACTEvery 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/ATTESTATIONSPlayer Attestation* I hereby accept the Georgia Athletic Coaches Association's invitation to play in the North-South All-Star Basketball Showcase being held on March 14, 2020 at Dalton High School, 1500 Manly Street, Dalton, GA 30720. 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*PaymentIf 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?*Select OneBy MailOnlineAll-Star Cost* Price: Processing Fee* Price: Total $0.00
