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.

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