HTML Preview Pre Enrollment Registration Form page number 1.
Thank you for your interest in Bright Horizons Family Solutions. Choosing a quality child care program is
one of the most important decisions you will make. We take your decision seriously and are committed to
living up to the important responsibility of caring for your child.
To register, please return this completed form, along with proof of program eligibility, to Bright Horizons
with a registration fee of $150.00 made payable to Bright Horizons. The registration fee is non-refundable
and is due annually at a reduced rate, when your child is enrolled in the program. Registration fees are
not refundable is applicants are found to be ineligible for program participation.
When your registration form and fee are received, you will be placed on a waiting list. You will be
contacted regarding the availability of space and the enrollment process. Prior to enrollment, Center
Administration will schedule a time for you to meet with your child’s primary caregivers to learn more
about Bright Horizons’ program and develop a visitation schedule for you and your child. The Center
Administration will review the parent/guardian policies/procedures and enrollment forms at that time.
Child’s Name: ____________________________________ Date of Birth: _____/_____/_____
Child’s Name: ____________________________________ Date of Birth: _____/_____/_____
Parent/Guardian Information:
Name: ______________________________ Name: _____________________________
Relationship: _________________________ Relationship: _________________________
Address: _____________________________ Address: _____________________________
_______________________________________ _______________________________________
E-mail Address: ________________________ E-mail Address: ________________________
Home Phone: _________________________ Home Phone: _________________________
Washington University Employee □Yes □No Washington University Employee □Yes □No
Full Time Graduate Student □Yes □No Full Time Graduate Student □Yes □No
Department: Department:
Company Name: ______________________ Company Name: ______________________
Company Phone: _____________________ Company Phone: _____________________
Days and Hours Desired:
MON __________ TUE __________ WED __________ THU __________ FRI _________
What date would you like enrollment to begin? _______________________________________
How did you hear about Bright Horizons? ___________________________________________
We will do everything possible to meet your needs, but we are unable to guarantee start dates. Enrollment is
based upon availability and is subject to priority enrollment rules of the Center.
Please enclose a check for the appropriate amount and return it to:
Washington University Family Learning Center
Ann Bingham, Center Director
840 Rosedale Ave, Campus Box 1237
St. Louis, MO 63112
Fax: (314) 935-3272
Phone: (314) 935-5437
annbingham@wustl.edu
_________________________________________________ _____________________
(Parent/Guardian’s Signature) (Date)
Thank you for choosing Bright Horizons Family Solutions.
Washington University Family Learning Center
Pre-Enrollment Registration/Waiting List
Application Form
For Administrative Use:
Date Registration Received: Date Info Entered Into IMS:
Check Number: Amount: