Empowered Learning enrollment forms

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

Step 1:
Call our office at 626-967-9337 to learn more about Empowered Learning or print and complete the following enrollment forms:
  1. Application
  2. Emergency Card
  3. Health History
  4. Consent Form and 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
  10. $20 registration fee per family; make check or money order payable to Options for Learning
Step 2:
  1. Documentation will be required for families interested in sliding scale/financial assistance. Please call our office at 626-967-9337 for information.
  2. All payments are due no later than the 5th of the program month and can be paid online.
Step 3:
Please print forms, sign and return via email to empoweredlearning@optionsforlearning.org or via mail to 885 S. Village Oaks Drive, Ste. 13, Covina, Calif. 91724.