PHC Payment Page - 9jacodekids Academy

Parent's Name *

First

Last

Parent's Email *

Parent's Phone *

Which camps are you enrolling for? (Select more than one camp and get camp bundle discounts) *

How many children are you enrolling? *

Child's Name *

First

Last

Child's Birthday *//

Child's Gender *

1st Child's Name *

First

Last

1st Child's Birthday *//

1st Child's Gender *

2nd Child's Name *

First

Last

2nd Child's Birthday *//

2nd Child's Gender *

3rd Child's Name *

First

Last

3rd Child's Birthday *//

3rd Child's Gender *

4th Child's Name *

First

Last

4th Child's Birthday *//

4th Child's Gender *

5th Child's Name *

First

Last

5th Child's Birthday *//

5th Child's Gender *

How Did You Find Out About Us?