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Brea Location
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Date:
Appointment Time:
Location:
Student's First & Last Name
Parent's First & Last Name
Email Address
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School
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ABC District (Cerritos)
Brea
Buena Park
Centralia (La Palma)
Chino Valley
East Whittier City
Fullerton
Hacienda La Puente Unified
Homeschooling
La Habra
Lowell Joint (Whittier)
Norwalk - La Mirada
Orange
Placentia - Yorba Linda
Private Schools
Rowland Heights
San Mateo-Foster City
Walnut Valley (Diamond Bar)
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Grade
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Phone Number
How did you hear about Optimus Learning School? (Select one)
Google Search
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Social Media:
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Referral:
Which of the following programs do you want to enroll your child in? (Check all that apply)
Afterschool
Summer Program
Homeschool
SAT Prep
AP Classes
Enrichment Class
Elective Class
GATE
Private Lesson (1:1 Tutoring)
Please specify AP Course:
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AP Physics
AP Calculus AB
AP Calculus BC
AP Chemistry
AP Computer Science
Please specify an Enrichment Class:
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Book
Writing
Math
Please specify an Elective Class:
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STEM
Coding
Chinese
Korean
Piano
Violin
Please specify a Subject for Private Lesson (1:1 Tutoring):
Are you inquiring for more than one student?
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Please tell us more details.
Choose a location
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Brea Location
Placentia-Yorba Linda Location