IRVINE

NEW CLASS ADDED

WEDNESDAY WORKING PARENTS

STARTS APRIL 27th
@4:30PM

MIXED AGE 6WKS to 2+

JUST LOOKING, BUT I WANT MORE INFO.

LEAVE YOUR EMAIL. WE'LL SEND YOU SOME STUFF... BUT NOT TOO MUCH STUFF.
Your Name*
First Last
Please enter your email:*
Enter Email Once more for the people in the back.

I'M READY. I'M READY.

ENROLL NOW WITH THE FORM BELOW.

CHOOSE A PROGRAM*

Child's First Name*

Child's Last Name*

Child's Date of Birth*

Child's Gender*

Male

Female

Parent A First Name*

Parent A Last Name*

Parent A Address*

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

Parent A Phone*

Parent A Email*

Enter Email Once more for the people in the back.

Is there another parent in the picture?*

Yes

Parent B First Name*

Parent B Last Name*

Parent B Address*

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

Parent B Phone*

Parent B Email*

Enter Email Once more for the people in the back.

Policies and Agreements

Parenting Program Schedule*

By checking this box, I understand that I am enrolling my child in Enrichment, beginning April 27, 2022 and concluding June 29th, 2022. I understand that this is a hands-on class and that my child must be accompanied by one adult (parent or caregiver).

Tuition Policy*

By checking this box, I understand that I am responsible for the total tuition associated to the classes and/or programs selected within this form. I understand that payment will be processed upon submitting this form and that all payments are non-refundable and non-transferable, regardless of absence or withdrawal.

Code of Conduct*

By checking this box, I understand that Piper Preschool reserves the right to discontinue enrollment in the event of a breach of this agreement and/or failure to act respectfully to all members of the Piper community.

Total

Credit Card

Card Details

Cardholder Name