Florida Hoops Regional Exposure Showcase

Florida U.S.S.S. A. present The U.S.S.S.A. Regional Showcase Series “One Day Exposure Camps for High School Athletes” Registration Form

Registration Fee (per showcase) Pre-registration must be postmarked by the Friday before the event. $95.00 Registration, anything postmarked after the Friday before or the day of the event. $125.00

Showcase Attending: Ft. Pierce, Treasure Coast Basketball Club Orlando, Winning Ways Jacksonville, NAABP Naples, CCYB Miami Tampa, Florida Elite

Player Information (Please print neatly). Last Name ______First Name ______Home Address ______Gender M F City ______Zip ______Date of Birth: ______Email ______Phone ______Grade: ______Player Position (circle only one): 1 2 3 4 5 Height: ____ - ____ Weight: ______Level played last year (circle only one) Varsity JV Freshman Other GPA: ______PSAT: ______SAT: ______ACT: ______Current High School: ______High School Coach: ______School Phone Number: ______Class Rank: ____ of ____ Club team: ______Club team coach: ______

Required Date and Signature Please enroll the above named athlete in the Basketball Event selected. I acknowledge that the participant is in good health and is able to participate in the physical activity of a vigorous program. The event coordinators have my permission to use their best judgment in any emergency that may require medical attention. I hereby authorize, exonerate and discharge any and all staff members from any liability for any injuries, trauma, suffering, permanent bodily injury or death incurred during the event or when traveling to or from the event. I also give full permission for PowerBasketball and Florida USSSA to utilize any photographs or video of participants for publicity and advertising purposes

Player Signature: ______Parent Signature ______

Date: ______Date: ______

This form is for Regional Showcase registration ONLY. Players will be informed via the Florida Hoops website if they will be selected for the State Showcase in Altamonte Springs. URL: http://www.PowerBasketball.com/fshl.html

Please make your check payable to the host association responsible for the Regional Showcase Event you are attending. ** For administrative purposes only. Team Assignment: ______Jersey #: ______

Please make your check payable to the host association responsible for the Regional Showcase Event you are attending.