Parent/ Guardian's Name *

First Name

Last Name

Student's Name #1 *

First Name

Last Name

Student Name #2

First Name

Last Name

Student Name #3

First Name

Last Name

Parent/Guardian Cell Phone *

(###)

###

####

Please choose one *

Mother & 1 Son - $20.00

Mother & 1 Son plus Adult T-Shirt - $27.00

Mother & 2 Son - $25.00

Mother & 2 Son plus Adult T-Shirt - $32.00

Mother & 3 Son - $30.00

Mother & 3 Son plus Adult T-Shirt - $37.00

Payment *

Please place payment in an envelope marked, "Mother/Son Picnic." Give envelope to front office.

Cash (Front office will give you a receipt)

Check (Make checks payable to: University Academy PTO)