Lifted Academy Portal

Date *

Student First Name *

Student Last Name *

Grade / Class *

Parent / Guardian Name *

Parent Email *

Parent Phone *

Uniform Items

Item

Color

Size

Qty

Price

$20.00

Line Total

$20.00

Student:

Grade/Class: —

Parent: —

Total Pieces: 0

Total Amount Due: $0.00

I understand that each uniform piece is $25.00. I understand that my order is not complete until the Lifted Academy office confirms payment.

I have read and agree to the terms & conditions above.