Parent & Child Fall 2021 Application

Please mark the appropriate day you would like to attend*
- 16-36 months: Thursdays 9:30am – 11:30am ($405)
- 12-24 months: Fridays 9:30am – 11:30am ($405)
Child's Name*
First Last
Gender*
- M
- F
Child's Birthdate:*
MM slash DD slash YYYY
Parent's Name*
First Last
Email Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
My child and I will be enrolled in Under the Oaks Parent and Child program during the above selected dates. By submitting this form I understand that all payments are non-refundable as costs for staff, insurance, rent etc. continue whether we attend or not. I agree to abide by the policies and procedures of Under the Oaks. Under the Oaks reserves the right to terminate a family’s contract at any time without cause for a refund of classes not yet attended.
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.