Application for Sr. High Camp
Complete this form for your students. Please note that payment for both coaches and students must be received by Oct. 25, 2019. If mailing one check, be sure to note who is being covered so we can properly credit payments for participants. Make checks payable to AGQBA. Your receipt of this form will serve as your invoice.

Mail payments to:
Malinda Pitts
Springdale High School
101 S Pleasant St.
Springdale, AR 72764

For further questions, please email Malinda Pitts at mpitts2@sdale.org.
Email address *
Coach's Name *
School *
Coach's Cell Number *
Coach attending?* *
Coaches do not have to attend but are encouraged to do so. Cost per coach is $85 to cover room and board. Payment must be received by Oct. 25, 2019.
2nd Coach attending? *
2nd Coach's Name
2nd Coach's Email
2nd Coach's Cell Phone
Students Attending
Each school may send up to FOUR students. Additional students may be added to a waitlist. Students will be added from each school if space is available. Coaches of students who were originally placed on the waitlist will be notified after Oct. 10 if space exists.
The fee per student is $60. Payment must be received by Oct. 25, 2019.
Name of Student 1 *
Gender of Student 1 *
This is required for room placement.
Grade of Student 1 *
Student 1's Shirt Size *
Name of Student 2
Gender of Student 2
Clear selection
Grade of Student 2
Student 2's Shirt Size
Name of Student 3
Gender of Student 3
This is required for room placement.
Clear selection
Grade of Student 3
Student 3's Shirt Size
Name of Student 4
Gender of Student 4
This is required for room placement.
Clear selection
Grade of Student 4
Student 4's Shirt Size
Student Waitlist
Please list students in order of preference. For each student, include gender, grade, and shirt size.
A copy of your responses will be emailed to the address you provided.
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