Registration Fee - Busy Minds Academy

Office use only: Student Enrollment Date

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. *

I am interested in enrolling in the Gravette/Hiwasse location
I am interested in enrolling in the Bella Vista location

The enrollment form takes approximately 15 minutes to complete, please have the following ready: *

Up-to-date vaccination record ready to upload
The payment for the registration fee will be collected at the bottom of this form
Once you submit this form, you will be redirected to a "Get To Know Your Child" form. Please fill this form out and bring it on your child's first day!
Please look over our Parent Handbook located on our website under the "Enroll" tab: https://www.busymindsacademy.com/wp-content/uploads/2023/04/2023-Parent-Handbook.pdf

A tour is required in order to complete this form. If you haven't scheduled a tour yet, please call or text Ms. Erica at 479-256-9180 *

I have already toured

Are you enrolling an infant that hasn't yet been born?

Yes
No

What is your due date?

Anticipated Start Date *

Schedule *

Full-time Monday through Friday
Part-time MWF
Part-time TTH

Child's Name *

First

Middle

Last

Child's nickname if any

Child's Birthdate *

Child's Gender *

Male
Female

Preferred Email for Communication *

Mother's Name *

First

Middle

Last

Mother's Phone Number *

Mother's Employer *

Mother's Work Hours *

Father's Name *

First

Middle

Last

Father's Phone Number *

Father's Employer *

Father's Work Hours *

Child's Address *

Address Line 1

City

State

Zip Code

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. *

First

Middle

Last

Relationship to child *

Address of Emergency Contact *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact's Phone Number *

Parent Signature *

Who does your child live with? *

Person responsible for paying Child's account charges: *

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. *

I understand

Supply fee is a $200 yearly fee and is charged in December through Brightwheel via auto-pay. *

I understand

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. *

I understand

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. *

Yes

Parent 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/2022/03/2022-Parent-Handbook.pdf *

Yes

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 *

Yes

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. *

Yes

Signature *

I give permission for employees of Busy Minds Academy to apply diaper rash ointment to my child whether center provided or parent provided. *

Yes
No

Signature *

I give permission for employees of Busy Minds Academy to apply insect repellant to my child whether center provided or parent provided. *

Yes
No

Signature *

I give permission for employees of Busy Minds Academy to apply sunscreen to my child whether center provided or parent provided. *

Yes
No

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 *

Yes
No

I give permission for employees of Busy Minds Academy to photograph or video my child for the following purposes: 1) Social Media *

Yes
No

I give permission for employees of Busy Minds Academy to photograph or video my child for the following purposes: 1) Website *

Yes
No

Signature *

I have received materials on prevention of Shaken Baby Syndrome *

Yes

https://humanservices.arkansas.gov/wp-content/uploads/Shaken-Baby-Brochure-English-1.pdf

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. *

Yes

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. *

Yes

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) *

Yes
No

http://arbetterbeginnings.com/parents-families/resource-library/kindergarten-readiness-checklist

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 *

First

Last

Phone *

Authorized person #2

First

Last

Phone

Authorized person #3

First

Last

Phone

Authorized person #4

First

Last

Phone

Please sign here authorizing the above persons to pick up your child:

Child's Physician *

Physician's Phone Number *

Physician's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Child's Preferred Hospital *

Does your child have any food allergies? *

Yes
No

List all food allergies:

Permission to post food allergies in classroom/kitchen: *

Yes
No

Does your child have any dietary restrictions? *

Yes
No

List all dietary restrictions:

Does your child have any illnesses or concerns that need to be addressed by the center? *

Yes
No

Describe any illnesses or concerns:

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.

Signature *

I understand that I may ask for a conference with my child's teacher as needed: *

Yes

Signature *

I understand that tuition will not be reimbursed if my child is absent or in the event of inclement weather *

Yes

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) *

Yes

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. *

I agree to let my child go on these walking field trips

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 understand that I will need to choose either the date in May or the date in August as my soon-to-be kindergartener's last day

I agree to send a message in Brightwheel to my child's teacher when I am on my way to pick up my child *

Yes

Signature *

Please upload your child's up-to-date vaccination record here. I recommend using the app "Genius Scan." You can also use your camera on your phone, but please be sure the image is clear and legible. *

Click or drag files to this area to upload. You can upload up to 3 files.

Is your child 6 weeks to 18 months? *

Yes
No

Getting ready for the first day! 6 weeks - 18 months

Is your child 18 months - 5 years? *

Yes
No

Getting ready for the first day! 18 months - 5 years

Non-refundable, one-time registration fee *

$200

Total *

$ 0.00

Stripe Credit Card *

Card

Name on Card