EmailMe Form - Mullen's JC Showcase (INDIANAPOLIS)

Full Name *

First Last

Date of Birth *

MM / DD / YYYY

Height (ex: 6-4) *

Weight *

Home Address

NOT your school address. The NCAA prefers your home/parents address. *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home/Parent's Phone *

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Player's Cell Phone *

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Twitter

Email *

Classification for 17-18' Season *

GPA *

ACT/SAT Score *

NCAA ID Number

College Credit Hours Earned *

Position *

School Attended During 17-18' Season *

School's City *

School's State *

Head Coach's Name *

First Last

Head Coach's School Phone Number *

### - ### - ####

Head Coach's Cell Phone *

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Head Coach's Email *

Additional information that could assist in your recruitment including awards & accomplishments

Health Insurance Company *

Insured's Name *

Policy # *

Group # *

Insurance Company Phone *

### - ### - ####

Applicant's Authorization & Signature

In the event of illness or injury, I hereby give my consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment and order injections, or surgery. WAIVER OF LIABILITY: In consideration of accepting this entry to MULLEN'S JC SHOWCASE, I, THE, undersigned, intending to be legally bound, hereby, for myself, my heirs, executors and administrators waive and release any and all claims for damages, demands, actions, and causes or actions against UNIVERSITY OF INDIANAPOLIS, their affiliates, subsidiaries, officials, representatives and employees. I attest and verify that I am physically fit and have sufficiently trained for the competition of this basketball event. We (or I) certify that (I or my) son is/am covered by the above medical insurance. *

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