Buri Buri LEAP - Spring  2016 Registration
You must complete the form and click "Submit"at the end to complete your registration.

Classes begin the week of April 11th.  Email confirmation will be sent with payment information until the classes are full.
Email Kelly Bohm at Daly City Partnership with any questions kelly@dcpartnership.org.

Note: For students enrolling in multiple classes: Submit for first class then use "submit another response" and fill out form again for additional classes. Siblings must submit separate responses.  
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Which class do you want to register this student for? *
Student Information
Please fill out the following information for the student:
Student Name *
Parent/Guardian Name *
Grade *
Room Number *
Dismissal Instructions *
For after care, please indicate after care room number below.
Dismissal Classroom - i.e. District room G111, etc
E-Mail Address: *
Emergency Contact 1 *
Please provide name, relation, and phone number
Emergency Contact 2
Please provide name, relation, and phone number
Emergency Contact 3
Please provide name, relation, and phone number
Does your child have any allergies or medical needs we should be aware of? *
Other Information
What other types of classes would you be interested in for your child(ren)?
Provide as much detail as possible.
Other comments, concerns, questions, scholarship requests:
Submit
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