Preview Pre Enrollment Registration Form

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: _____/_____/_____

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:

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