Empowered Learners Private School Enrollment Form 2026-2027 School Year

Empowered Learners Private School Enrollment Form 2026-2027 School Year
My child, * will be attending school at Empowered Learners Private School for the 2026-2027 school year.
This form is to ensure your child's spot at Empowered Learners
I understand that I will be responsible for paying a non-refundable fee of $250 for Pre-K-5th Grade and $350 for 6th-10th Grade to cover the cost of curriculum and supplies.
Initial Here: *
Child's Name*

First NameLast Name
Child's DOB*

MonthDayYear
Date
Child's grade level for the 2026/2027 school year*
Full Time (Monday-Thursday)Part Time (Tuesday and Thursday)Undecided at this timeRemote Learning (Online Only)
Parent Name*

First NameLast Name
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
I understand that I am responsible for 10 scheduled tuition payments for the 2025-2026 school year for the months of August - May.
Initial Here: *
Should be Empty:

This form is to ensure your child's spot at Empowered Learners