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.

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 *
Your answer
School *
Your answer
Coach's Cell Number *
Your answer
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
Your answer
2nd Coach's Email
Your answer
2nd Coach's Cell Phone
Your answer
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 *
Your answer
Gender of Student 1 *
This is required for room placement.
Grade of Student 1 *
Student 1's Shirt Size *
Name of Student 2
Your answer
Gender of Student 2
Grade of Student 2
Student 2's Shirt Size
Name of Student 3
Your answer
Gender of Student 3
This is required for room placement.
Grade of Student 3
Student 3's Shirt Size
Name of Student 4
Your answer
Gender of Student 4
This is required for room placement.
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.
Your answer
A copy of your responses will be emailed to the address you provided.
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