LEAPSTART AFTER SCHOOL Enrollment form

LEAPSTART AFTER SCHOOL

APPLICATION FORM

Today's Date*

Today's Date

Pick School Year for Application*

2024-25 School Year

Child's Information

Existing Student?*

Existing Student Name*

Applying with siblings?

SIBLING DISCOUNT is available for parents registering multiple children

Sibling Names*

Enter sibling names separated by comma

Congratulations! You qualify for Sibling discount calculated as below for both monthly and yearly plans.

5 days monthly: $35 per month for 2nd Child onwards

3 days monthly: $20 per month for 2nd Child onwards

First Name*

Last Name*

DOB*

Date

Gender*

School Name*

Grade*

Home Street Address*

City*

Zip Code*

State*

Referred By

If you are referred by an existing customer of Leapstart, pl. mention their name here.

Any Allergies or other medical conditions that our staff needs to be aware of?

Parents Information

Mother"s Name*

Mom's E-mail*

Mom's Phone*

Mother's Employer*

Father"s Name*

Father's E-mail*

Father's Phone*

Father's Employer*

Emergency Contact & phone

After School Programs

All Inclusive Monthly Price includes pickup, lunch, Homework/ Academic guidance & some of enrichment programs as mentioned on the website as well as holidays from morning 8:30am - 6:30pm

5 Days a week

After School Program

4 Days a week Program

After School until 6:30pm

3 Days a week

After School Program

2 Days a week Program

After School until 6:30pmSchool Pick up

Pick days of the week you need services on

Leapstart Location for Application*

De Anza Center, 10594 S De Anza Blvd Cupertino CA 95014Bubb Center, 10650 Bubb Rd Cupertino CA 95014

Pickup option*

Regular pickup by 6:30pmEarly pick up by 5:30pm - save $100 on 5 days a week plan in monthly fees. Not available on 3 day program

Requested Start Date

Available Start Dates*

Pl. keep one week for paperwork and payment setup on our system

Application Fee (Non Refundable)

Registration Policy: On completing this form, you shall be given the links to create an account on our Student Portal. On creating an account, you will be provided links to documents required to be completed by you as well as payment information setup on the portal. Kindly note we can not provide any service wthout completed paperwork from your side and we can only hold the spot without it for one week max. We reserve the right to offer your spot to next family on the waiting list after that. The application fee shall continue to be non refundable in this case.

Waiting List Policy: We will keep your child's name in the waiting list for the entire school year. Waiting list is served on 1st come 1st basis and we will contact you if or when a spot becomes available for your child. When a spot becomes available, we will contact you by email. In case of no response from you, we shall offer the spot to the next family in line after waiting for your response for 48 hours. The application fee shall continue to be non refundable in this case.

Registration Fee*

$150.00$75.00 (Discount for 2nd child registration)

HAVE A PROMO CODE?

Payment Information

PROMO CODE VALUE

Leapstart runs promotions on FB, LinkedIn, Nextdoor occasionally

Final $*

EB Discount

Sibling Discount

Calculated Total*

My Products

USDTotal payment today

Payment Methods

Credit Card

Apple Pay

Google Pay