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Korean School
Blog
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Contact Us
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Enroll
📞 (818) 846-6477 | 📍 2021 W. Glenoaks Blvd. #110, Glendale, CA 91201 (Inside Glendale Church)
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2026-2027 SCHOOL YEAR
Enrollment Form
Please complete all sections below to finalize your child's enrollment at Top Learning Center.
Have questions before you submit? Call us at (818) 846-6477 — we are happy to help.
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Last Name
*
STUDENT INFORMATION
First Name
*
Middle Name
Date of Birth
*
Gender
*
Male
Female
Grade
*
Address
*
City
State
Zip Code
School Name
School District
Have you tried another program before?
Mother's Cell
PARENT / GUARDIAN CONTACT INFORMATION
Have Signature Phone
Father's Cell
Email
*
Home Phone
Emergency Phone
*
Preferred Days
Monday
Tuesday
Wednesday
Thursday
Friday
CLASS SCHEDULE — Select preferred days
Insurance Company
INSURANCE & HEALTH INFORMATION (For Emergency Use Only)
Insurance Phone
Agent's Name
Policy No.
Family Doctor's Name
Doctor's Office & Phone
Medical Conditions
Asthma
Diabetes
Heart trouble
Other Medical Condition (please specify)
Tendencies to Note
Fainting
Convulsion
Nosebleeds
Other Tendency (please specify)
Allergies
Food
Plants
Medications
Animals
Bee stings
Other Allergy (please specify)
Other Illnesses or Health Notes
Acknowledgement of Enrollment
*
I acknowledge the above and confirm all information on this form is correct.
The registration fee is due at the time of enrollment. The tuition fee is due by the first day of each 4-week session. If the student wants to reschedule class to a different date, the instructor should be informed at least two days in advance. If the student will withdraw from our program, parents should give at least 2 weeks notice. The parent(s) or guardian(s) shall be liable for all damages and injuries incurred and/or caused by the student.
Parent/Guardian Signature (Type Full Name)
*
Date Signed
*
Submit Registration Form