Parent & Child Summer 2019 Application

Parent and Child Enrollment: Summer 2019 Wednesday – July 3 through July 31 Thursday – July 11 through August 1
Please mark the appropriate class you would like to attend*
- 12-18 months: Wednesdays 9:30am - 11:30am ($225)
- 18-36 months: Thursdays 9:30am - 11:30am ($180)
Child's Name*
First Last
Gender*
- M
- F
Child's Birthdate:*
MM slash DD slash YYYY
Parent Name*
First Last
Email Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Parent Name*
First Last
Email Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
PAYMENT*
- Visa
- MC
- AMEX
- Check Payable to Under the Oaks Preschool
Under the Oaks ECC, 3480 Las Flores Cyn, Malibu CA 90265 (310) 456-7111, (310) 266-7139
Name on Card
Card Number

3% 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

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Download the form PDF here to fill out and mail or fax to us. Or you can continue with this online form above and press Next.