Bright Minds & Mud Pies Learning Center

Enrollment Application

Please complete all sections below. Once submitted, a staff member will review your application and contact you within one business day.

📝  $75 registration fee is due upon director assignment of start date
1
Child Info
2
Parent / Guardian
3
Medical
4
Emergency Contacts
5
Schedule
6
Agreements
🎉 Thank you! Your enrollment application has been received.
A staff member from Bright Minds & Mud Pies will contact you within one business day.

Questions? Call us at (314) 918-5285
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Section 1 — Child Information
Information about the child being enrolled
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Section 2 — Parent / Guardian Information
Primary and secondary contact information
Primary Parent / Guardian

Secondary Parent / Guardian (if applicable)
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Section 3 — Medical & Health Information
Required for your child's safety. All records must be on file by start date.

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Detailed health records are collected in person

To keep your child's medical information private, we do not collect allergy details, diagnoses, medication schedules, or insurance and Medicaid numbers through this website. Please answer the questions below so our staff knows what to prepare for — we'll gather the full details securely, in person, on or before your child's first day.

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Section 4 — Emergency Contacts
3 contacts required. These persons may also pick up your child. Photo ID will be required.
Emergency Contact #1
Emergency Contact #2
Emergency Contact #3
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Section 5 — Requested Childcare Schedule
All students must be dropped off by 9:00 AM. Max 10 hours per day. Mon – Sun available.

Please enter your expected drop-off and pick-up times for each day you need care. Leave blank for days not needed. Note: Schedule changes require a 2-week notice and a $25 change fee.

Day
Drop-Off Time
Pick-Up Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Section 6 — Agreements & Consent
Please read and acknowledge each policy before submitting

Electronic Signature

By typing your name above, you acknowledge that you have read, understood, and agree to all policies stated in this enrollment application. This serves as your electronic signature.

Ready to Submit?

Review your information above, then click the button below.
We'll be in touch within one business day to confirm your enrollment.

Your information is private, secure, and never shared with third parties.