California State Forms Required For Family Day Care Enrollment

  1. Can complete forms online or you can print a copy of each form listed below and complete.
  2. Make note of anything you are not sure of.
  3. Bring all forms with you at time of enrollment.
  4. We will review forms together.

LIC 282 Affidavit Regarding Liability Insurance                                                                                                     LIC 613a Personal Rights

LIC 627 Consent for Emergency Care                                                                                                                    LIC 700 Identification & Emergency Information

LIC 702 Child's PreAdmission Health History Parent's Report                                                                             LIC 995a Notification of Parents Rights

LIC 995e Caregiver Background Check Process                                                                                                  LIC 9150 Parent Notification Addition Children in Care             

LIC 9166 Nebulizer Care Consent-Verification                                                                                                       LIC 9212 Consumer Awareness Info             

PM 286b Immunization Record (Current)                                          

(please bring your child's immunization record with you and we will complete the blue form in the home).