Application - Parent & Child Full Year 2016 - Under The Oaks PreschoolUnder The Oaks Preschool

Please mark the appropriate day you would like to attend according to the age of your child by September, 2016*

Child's Name*

First Last

Gender*

Child's Birthdate:*

Multiple Children

Please enter in the Full Name and Birthdate for each additional child. There is a 20% discount for Twins.

Mother's Name*

First Last

Email Address

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Father's Name*

First Last

Email Address

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

PAYMENT*

Under the Oaks ECC, 3480 Las Flores Cyn, Malibu CA 90265 (310) 456-7111, (310) 266-7139

Name on Card

Card Number

2% surcharge on all Credit Card charges / Session must be paid in full prior to session start

Expiration Date

MM/YYYY

CVV Code

3-4 digit code on your credit card

Billing Zip Code

Parent & Child Full Year 2016: Sept 13, 2016 through June 3, 2017