Application for Jr. High Camp

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Complete this form for your students. Please note that payments should be brought with you to camp. Be sure to note on the check who is being covered so we can properly credit payments for participants. Make checks payable to AGQBA. $25 per student and $15 for a coach who wants a shirt.

Each school must provide 1 Coach or adult per 5 students.

Registration Deadlines:
Pulaski Middle, Little Rock (11/6)--10/15
Russellville JH, Russellville (12/11)--11/19

For further questions, please email Nita Wimberly at wimberlyn@whitehallsd.org

Receipt of this gForm is your invoice.

Email *

Camp you are attending *

October 17th--UACCB (Batesville)

November 6th- Pulaski Middle School (Little Rock)

December 11th--Russellville Jr. High (Russellville)

Coach's Name *

School *

Coach's Cell Number *

Number of Coaches attending?* *

One (1) coach or adult is required per every five (5) students. Coaches are free to attend. T-shirts are $15 per shirt.

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