CSUSB Infant/Toddler Lab School
ENROLLMENT APPLICATION
WINTER Quarter 2016
Thank you for your interest in the CSUSB Infant/Toddler Lab School. We offer full and part day care for children from 6
months through 36 months of age. We are a full cost care center. Once your completed application is submitted to our
office, you will be placed on the waiting list. Please read the following information carefully before completing the
application.
The attached application is NOT a registration form; it is an eligibility/waiting list application only. Parents will be notified by
phone ONLY if and when their child is accepted for registration. If a child is not initially accepted, the application will remain
active for the current academic quarter and notification will be made if space becomes available. It is each parent’s
responsibility to notify the center at 537-5661 of any changes involving telephone numbers or schedule changes.
It is also each parent’s responsibility to RESUBMIT a new application for each upcoming academic quarter.
APPLICATION PROCEDURE:
1. Complete the Eligibility Application. Make sure to carefully and accurately complete every item. Applications
submitted with missing information will NOT be processed.
2. Complete a report from your child’s physician and make sure to have a copy of your child’s immunization records
(physician’s report is attached).
3. Return the completed application, physician’s report, and immunization records to the Infant/Toddler Lab School.
Waiting list applications for the winter academic quarter will not be accepted until November 2, 2015. Applications
will be accepted on an on-going basis. This application is for the Winter 2016 quarter only.
4. You will be notified by telephone approximately the first week of December if your child is accepted into the
program. You are welcome to call the center at any time to check on the status of your application. If your child is
accepted into the program, there is an $85.00 initial registration fee. If you decide to take the slot, you will be
given 72 hours to pay $15 of the $85 registration fee in order to hold your spot.
Mail the completed application to:
(or you can drop it off in the office)
CSUSB Infant-Toddler Lab School
5500 University Parkway SB-145
San Bernardino, CA 92407
Academic School Year Hours: Mon-Thurs. 7:30am-8:00pm; Fri 7:30am-4:00pm
(This does not include the summer quarter.)
Tuition Rates for Infants & Toddlers
Full days 7:30-4:00
Mon-Fri
Mon-Thurs
Mon, Wed, Fri
Mon, Wed OR Tues, Thurs
$ 300/week
$ 260/week
$ 205/week
$ 145/week
Half days (you will choose a.m. or p.m.) a.m.= 7:30-12:00am ; p.m.= 12:00-4:00pm; evening= 4:00-8:00
Mon-Fri
$ 170/week
Mon-Thurs
$ 140/week
Mon, Wed, Fri
$ 110/week
Mon, Wed OR Tues, Thurs
$ 75/week
Drop-In Hourly Rate: $9.50/hr – minimum of 2 hours per day
(space available basis only)
CSUSB Infant/Toddler Lab School
ELIGIBILITY APPLICATION
Winter 2016 Quarter ONLY
January 11 to March 25
Please list each child for whom application is being submitted:
Child’s Name
M/F
Birth Date
Age
_______________________________________________
______
___/___/___
_____
_______________________________________________
______
___/___/___
_____
CSUSBStudent? Faculty?
Staff?
Applicant Parent’s Name______________________________ Yes___ No___ Yes__ No__ Yes__ No__
Other Parent’s Name_________________________________ Yes___ No___
Yes__ No__ Yes__ No__
Home Address____________________________________________________________________________
Primary Phone # (_____)______________________ Secondary Phone # (_____)_____________________
Email address: ___________________________________
What days/times will you need care? Please estimate as close as possible.
We will use this information to determine your child’s eligibility for the program.
You may choose one of four options:
a.m. program: 7:30am-12:00pm
Full-day program: 7:30am-4:00pm
p.m. program: 12:00-4:00pm
Evening program 4:00-8:00pm
Please select your child’s desired program below.
You may choose: Mon-Fri; Mon-Thurs; Mon, Wed, & Fri; Mon/Wed; or Tues/Thurs:
Monday
___a.m. ___p.m.
Tuesday
___a.m. ___p.m.
Wednesday ___a.m. ___p.m.
Thursday
___a.m. ___p.m.
Friday
___a.m. ___p.m.
___evening
___evening
___evening
___evening
___full-day
___full-day
___full-day
___full-day
___full-day
Our center’s hours are: Mon-Thurs 7:30 am-8:00 pm, Friday 7:30 am-4:00 pm
Do you plan on applying for CCAMPIS funding? ________Yes ________No
Please see: http://ccampis.csusb.edu/ or call (909) 537-7782 for more information.
Comments:______________________________________________________________________________________________
“I certify that all of the above information is true and correct and that I have read and completely understand the Enrollment
Policies and Procedures attached to the application.”
Signature______________________________________________________ Date____________________________
For Office Use Only:
Date received:__________________________
Date family was contacted:___________________ Outcome of the call:_____________________________________________________
Comments: