WAITING LIST APPLICATION
CHILD DEVELOPMENT PROGRAM- Cub and Cougar Programs
WASHINGTON STATE UNIVERSITY VANCOUVER
14204 NE Salmon Creek Avenue Vancouver, WA 98686
PHONE: 360/546-9722 FAX: 360/546-9076
http://hd.vancouver.wsu.edu/child-development
EMAIL: [email protected]
WSU Vancouver's Child Development Program (CDP) is open to children of students, staff, faculty, and the
general public. We accept children 2 ½ to 5 years of age for the CUBS/COUGARS program on a first come, first
served, space available basis. Children must be 2 ½ years of age on or before beginning the CUBS program.
APPLICATION DOES NOT INSURE FINAL ADMISSION.
Upon completion of this application your child will be placed on a waiting list.
This form must be returned with a required $35 application fee paid via personal check,
money order, or cashier’s check made payable to Washington State University.
No cash accepted. This fee is not refundable.
Return this completed application form to the CDP at the address above.
Child's Full Name: _______________________________________________
Child's Birth Date: _______________________
M
Child's Home Address:
City: ______________ State: ____ Zip: _________
Home Phone:
F (indicate child's sex by circling appropriate letter)
Family E-mail Address:
Parent/Guardian Name(s):
Relationship to child:
Day phone:
Siblings attended CDP?
Yes
or
No
WSU Faculty/Staff/Student? Y or N __________________
(Please specify)
Are you now receiving or do you plan on applying for a Washington State Child Care Subsidy? Yes
Signature:
or
No
Date:
PLEASE NOTE: You are responsible for informing us in writing of any changes in address or telephone number.
The program will cancel the application if the parent cannot be located.
Make checks payable to “Washington State University” and deliver or send them to:
Child Development Program
Washington State University Vancouver
14204 NE Salmon Creek Ave
Vancouver, WA 98686
USDA STATEMENT: In cooperation with the Child Care Food Program, no child will be discriminated against because of race, color, handicap,
age, sex, religion, or national origin. If you believe you have been discriminated against in any USDA-related activity, you should write immediately
to the Secretary of Agriculture, Washington D. C. 20250.
Over for Session Options
Washington State University Vancouver
Child Development Program
2017-2018 Academic Year
Please check the CUBS (2 ½ - 3 ½ YEARS OLD) schedule to be reserved for your child:
Full Day
(7:30 am - 6:00 pm)
*Morning snack, fruit and milk at lunch,
afternoon snack & late afternoon snack
Monday through Friday
$950/month
Monday through Thursday
$845/month
Three Days
$670/month
Tuesday, Thursday
$450/month
Monday, Wednesday
$450/month
Place an X in the box below of
your preferred schedule
When are you interested in starting at the CDP CUB’s Program: ___________________________
Please check the COUGARS (3 ½ - 5 YEARS OLD) schedule to be reserved for your child:
Full Day
(7:30 am - 6:00 pm)
*Morning snack, fruit and milk at lunch,
afternoon snack & late afternoon snack
Monday through Friday
$950/month
Monday through Thursday
$845/month
Three Days
$670/month
Tuesday, Thursday
$450/month
Monday, Wednesday
$450/month
Place an X in the box below of
your preferred schedule
When are you interested in starting at the CDP COUGAR’s Program: _______________________
Overtime Charges: Assessed for any amount of time your child is present before or after scheduled hours. Overtime
rates are $1.00 per minute after 6:00pm.
Payments for scheduled hours must be made in advance, no later than the tenth of each month. A $25 late payment fee is
assessed for bills not paid in full by the tenth of each month. Tuition payments must be made via personal check, money
order, or cashier’s check. Alternative payment schedules can be discussed with the Administrative Assistant.
Tuition has been figured at a rate that does not include days the program is closed for summer break. Therefore, the full
monthly tuition remains the same regardless of whether the program is closed.