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Child's Name
Thank you for choosing Busy Minds Academy! If your child's classroom is currently at capacity, we will add your child to our waitlist. Our waitlist is first-come, first-serve. Please note that the one-time registration fee is non-refundable.
What location are you interested in enrolling in? Please check with us for availability at each location. You need to reach out to Busy Minds to see which location has availability.
The enrollment form takes approximately 15 minutes to complete, please have the following ready:
A tour is required in order to complete this form. If you haven't scheduled a tour yet, please call or text Ms. Tanya at 479-256-9180
Are you enrolling an infant that hasn't yet been born?
Anticipated Start Date
Schedule
Please upload a picture of your child here:
Click or drag a file to this area to upload.
Child's Birthdate
Child's Gender
Mother's Name
Father's Name
Child's Address
Person to contact in the event of emergency if the parent cannot be reached. This person has permission to pick up child and make any decision regarding the child.
Address of Emergency Contact
Clear Signature
Payments through Brightwheel ONLY, using auto-pay. Brightwheel can be accessed online at https://schools.mybrightwheel.com/sign-in, but the Brightwheel smartphone app is preferred and recommended. Payment is due every Friday, a late fee of $50 will be assessed on Monday to all balances. Children will not be allowed to attend on Tuesday if balance is not paid in full (including late fees).
Registration fee is a one-time fee: $200 per child.
Supply fee is a $200 yearly fee and is charged in December through Brightwheel via auto-pay.
We do not allow students to drop care just for the summer and return in the fall.
A 4 weeks withdrawal notice is mandatory. It must be emailed to hello@busymindsacademy.com at least 4 weeks before withdrawal or a 4 week charge will be charge will be added to the account upon termination in lieu of proper notice.
Total cost per week for my child's program is:
I understand and agree to pay Busy Minds Academy each week that my child is enrolled. I understand and agree that I owe this amount per week for his/her spot in the center and am charged regardless of attendance. I understand and agree that this constitutes a binding agreement and non-payment will result in legal action. I understand and agree that to unenroll my child, I must email the school at hello@busymindsacademy.com at least four weeks in advance or I will have an additional 4 weeks charge on my account in lieu of withdrawal notice.
Clear Signature
I have received and reviewed a written description of the Busy Minds Academy program and policies. Available both online and in a printed form (Parent Handbook) https://www.busymindsacademy.com/wp-content/uploads/2023/04/2023-Parent-Handbook.pdf
Clear Signature
I have been informed of the behavior guidance policy practiced. Behavior guidance is located in our parent handbook. https://www.busymindsacademy.com/wp-content/uploads/2022/03/2022-Parent-Handbook.pdf
Clear Signature
I authorize Busy Minds Academy to care for my child during the time he/she is in the facility and to obtain emergency medical treatment and transportation for my child in the event that I cannot be reached.
Clear Signature
I give permission for employees of Busy Minds Academy to apply diaper rash ointment to my child whether center provided or parent provided.
Clear Signature
I give permission for employees of Busy Minds Academy to apply insect repellant to my child whether center provided or parent provided.
Clear Signature
I give permission for employees of Busy Minds Academy to apply sunscreen to my child whether center provided or parent provided.
Clear Signature
I give permission for employees of Busy Minds Academy to photograph or video my child for the following purposes: 1) Brightwheel *Please note if you select NO to this question, you will not receive any photos throughout the day of your child via Brightwheel
I give permission for employees of Busy Minds Academy to photograph or video my child for the following purposes: 1) Social Media
I give permission for employees of Busy Minds Academy to photograph or video my child for the following purposes: 1) Website
Clear Signature
I have received materials on prevention of Shaken Baby Syndrome
https://humanservices.arkansas.gov/wp-content/uploads/Shaken-Baby-Brochure-English-1.pdf
Clear Signature
I have been informed that childcare licensing/child maltreatment investigators and/or law enforcement may possibly interview my child for the purpose of determining licensing compliance or for investigative purposes.
Clear Signature
Licensing compliance forms (DCC-521) shall be available at the facility for three (3) years. I have been informed that the compliance forms are available for review upon request.
Clear Signature
I acknowledge that I have received a copy of or given the website address to the electronic version of a list of Kindergarten Readiness Skills for my child (3 -5 year olds)
http://arbetterbeginnings.com/parents-families/resource-library/kindergarten-readiness-checklist
Clear Signature
No unauthorized persons will be allowed to pick up your child. Please list all authorized person here. *Please notify the individual that they will be asked to show proof of identity*
Authorized person #1
Authorized person #2
Authorized person #3
Authorized person #4
Clear Signature
Physician's Address
Does your child have any food allergies?
Does your child have any dietary restrictions?
Does your child have any illnesses or concerns that need to be addressed by the center?
I do give my consent to the directors and teachers of Busy Minds Academy for my child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of an emergency when the parent cannot be reached. Consent is also given for the director or teacher to transport the child listed on this application for emergency medical treatment, if the parents cannot be reached.
Clear Signature
I understand that I may ask for a conference with my child's teacher as needed:
Clear Signature
I understand that tuition will not be reimbursed if my child is absent or in the event of inclement weather
Clear Signature
I understand that my child must be dropped off for school BEFORE 9:00 am. I understand that I will be charge $30 for a drop-off after 9:00 am. (with the exception of appointments). I also understand that Busy Minds opens at 7:00 am and any child checked in before 7:00 am will incur a $30 charge.
Clear Signature
Occasionally, we go on walking field trips to Ms. Tanya's home or to the surrounding common property, including to the walking trail near Busy Minds. (This is only for our Bella Vista location)
Graduating Preschoolers that are headed to Kindergarten have two dates to choose for their student's last day: The 4th Friday in May or the 2nd Friday in August
I agree to send a message in Brightwheel to my child's teacher when I am on my way to pick up my child
Clear Signature
Click or drag files to this area to upload. You can upload up to 3 files.
Is your child 6 weeks to 18 months?
Is your child 18 months - 5 years?
Non-refundable, one-time registration fee
$0.00
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