Parent Name *

First Name

Last Name

Parent's Phone #

(###)

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Student Name *

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

I understand that I will have to pay the amount of $50 (per child) to Starkville Academy and will send a form of payment to the elementary office or with my child to school. *Price includes t-shirt and admission to the game* *

I agree