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Empowered Learning enrollment forms

Apply today ... it's quick and easy!

Step 1:
Call our office at 626-699-8070 to learn more about Empowered Learning to discuss your enrollment options.
 
Step 2:
Review and complete the following forms:
  1. Application
  2. Emergency card and consent form
  3. Health history
  4. Photo release
  5. Personal rights
  6. Parents' rights
  7. Annual notification of possible pesticide use
  8. Resource information
  9. Client Non-Admittance and Termination Policy
Step 2:
Additional information:
  1. Documentation will be required for families interested in sliding scale/financial assistance. Please call our office at 626-699-8070 for information.
  2. Click here to view fee schedule for full-year enrollment (coming soon; please check back).
  3. Families enrolling in the full-year option are required to submit a $20 registration fee; instructions for payment will be provided after your application is received and activated.
Step 3:
Forms may be returned as follows:
  • In person with an appointment;
  • By mail to Empowered Learning, 885 S. Village Oaks Drive, Suite 13, Covina, Calif. 91724;
  • By email at [email protected].
 
Please make sure that all forms are complete and signed before submitting them.