Mail-in/Fax/E-mail Registration Form

Please mail and pay by Money Order ($115.00) or Credit Card(Bottom of page) and mail/fax/email to:

ScoutsFocus

C/O Joe Davis

PO BOX 2563

Greenville, NC 27836

Payment Phone: 281.896.8638

Fax: 888.380.8149

Email:

Must be postmarked at least 10 days prior to desired camp date or it will not be accepted. Within 10 days of preferred showcase location; online, fax and phone registration are the only allowed methods, space permitting.

Check Desired Camp(s):

Saturday, September 1

Los Angeles, CA (Players Edge, Corona, CA)

Sunday, September 2

Bay Area, CA (Contra Costa College)

Saturday, September 8

Dallas, TX (Grand Prairie HS)

Sunday, September 9

Austin, TX (Akins HS)

Saturday, September 15

Chicago, IL (Joy of the Game, Deerfield)

Sunday, September 16

Indianapolis, IN (Noblesville Boys and Girls Club)

Saturday, September 22

Atlanta Area (Players Park, Marietta, GA)

Sunday, September 23

Charlotte, NC (Gaston Day School)

Saturday, September 29

Houston, TX (Harvest Time Church)

Sunday, September 30

DC Area (Discovery Sports Center, Boyds, MD)

Saturday, October 6

Philly (Christian Life Center Academy, Burlington,NJ)

Sunday, October 7

NYC (Northsport Athletic Facility, Northport, NY)

Saturday, October 13

Raleigh, NC (JD Lewis Center)

Sunday, October 14

Hampton, VA (Boo Williams SportsPlex)

Saturday, October 20

Miami, FL (Miami Springs Recreation Center)

Sunday, October 21

Orlando, FL (Orlando Sports Center)

Sunday, October 27

Boston, MA (Kroc Center)

Saturday, November 3

Eagan, MN (High Performance Sports Academy)

Please fill out as much info as possible as it will be made available to scouts and college coaches:

Camper Name______Camper Email______ Camper Cell______

Street______Apt______City ______State Zip______Home Phone______

School School Street Address______School City-State-Zip ______

Birthday______Height______Weight______Position______Grad Year______ Shirt Size______

AAU Team Name______AAU Coach______AAU Coach Cell______AAU Email______

High School Coach Name______Cell______Email______GPA/SAT/ACT______

Parent/Guardian Name______Cell______Email______Cell #2______

Insurance carrier______Policy #______Group #______

I, the undersign, submit that my son is physically fit and able to participate in strenuous activity and hereby waive ScoutsFocus of all responsibility for illness or injury sustained. I hereby authorize camp personnel and directors to act on my behalf in their best judgement in any medical situation. I understand I am solely responsible for payment of any such medical expenses and must provide ScoutsFocus with proof of medical and accident insurance. I also understand that my payment is non-refundable and non-transferable under any circumstances.

Parent Name & signature______Date______

One Showcase Fee: $115

Additional options (See scoutsfocus.com/cancel.html for cancellation insurance information):

Highlight Video+Evaluation: $50 Online Profile: $25 Scouting Video+Highlight+Evaluation: $75 Cancellation Insurance: $10

Credit Card Number______Expiration______

Cardholder Name______Security Code______

Billing Street Address and Zip Code______

Amount Authorized $______

Signature______Date______

Office Use Only: Amount Payed______Balance______Date Rec’d______Processing Enployee______