Children's Center

CSUB Children’s Center New Families Forms

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All forms can be completed within Adobe Reader. Simply type in the fields and print out the completed form. Some forms will not allow you to complete certain fields, as those must be filled out with a pen.

Download Adobe Acrobat Reader Here.

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STEP 1. ENROLLMENT FORMS

STATE MANDATED FORMS

• Child’s Pre-Admission Health History - (PDF) (Lic 702)
• Physicians Report (PDF)
  • (Lic 701-must be signed by physician)
• Parents Rights (PDF) (Lic 995)
• Personal Rights (PDF) (Lic 613A)
• Important Information about Employee Background Checks (PDF)
  • (Lic 995F- informational only)
• Parent Agreement form
• Emergency Information and Medical Release

HEALTH AND SAFETY FORMS

• Emergency Kit Information
  • (all items to be brought to enrollment appointment)
• Nebulizer Care Consent (PDF) (Lic 9166)
  • (To be completed for each child requiring inhaled medication while at the Center. A separate form must be completed for each person who administers inhaled medication to the child. Must be updated annually.)

FAMILY PROVIDED INFORMATIONAL FORMS

• Parent Directory Information
• Race/Ethnicity Form

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STEP 2.

ADDITIONAL ITEMS TO BE BROUGHT TO THE OFFICE

• Child’s Yellow Immunization Card/Record
• Emergency Kit (with all requested items in a Ziploc bag)
• Copy of CSUB printed class schedule showing your name
  • (CSUB Students only)
    

 

CHILDREN’S CENTER MANUALS and GENERAL INFORMATION
               

• Parent Handbook
• Parent Handbook Receipt
• Nap bedding information

 

Subsidy & Scholarship Information

If you think you may qualify for State subsidized funding or scholarship funding and have not already applied, please fill out the following forms and bring in the following information:

• Scholarship application
• Subsidy application (2 parts-CD9600, CD9600A)
  • CD9600
  • CD9600A

 

One month’s worth of pay stubs for each working parent in the home

• Work verification form for each working parent in the home
• Training Verification Form (PDF) (CD9605)
• Birth certificates for all children living in the home
• Print out of school schedule for each parent who attends school
• PG&E bill (or some other utility bill that provides proof of address)