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The Lic 700 form is a crucial document for child care centers and family child care homes in California, facilitating essential communication between parents and providers. This form is designed to gather vital identification and emergency information about each child enrolled in the program, ensuring their safety and well-being. Parents or authorized representatives fill it out, providing details such as the child's name, date of birth, and address. It also collects information on guardians, including their contact numbers and addresses, which helps in emergencies. The form further identifies key contacts who can be called upon if parents are unavailable, including physicians and dentists, along with instructions on what action to take in case the primary contacts cannot be reached. Importantly, it specifies individuals authorized to pick up the child, ensuring no one can remove the child from the facility without proper consent. The Lic 700 form promotes a structured approach to child care management, enhancing both safety and communication, while also providing peace of mind to parents. Overall, this form serves as a foundational tool in managing the health and safety of children in care settings.

Lic 700 Example

STATE OF CALIFORNIA

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

IDENTIFICATION AND EMERGENCY INFORMATION

CHILD CARE CENTERS/FAMILY CHILD CARE HOMES

To Be Completed by Parent or Authorized Representative

CHILD’S NAME

LAST

MIDDLE

FIRST

SEX

TELEPHONE

 

 

 

 

 

 

 

 

(

)

ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

BIRTHDATE

 

 

 

 

 

 

 

FATHER’S/GUARDIAN’S/FATHER’S DOMESTIC PARTNER’S NAME

LAST

MIDDLE

 

FIRST

 

BUSINESS TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

HOME ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

HOME TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

MOTHER’S/GUARDIAN’S/MOTHER’S DOMESTIC PARTNER’S NAME

LAST

MIDDLE

 

FIRST

 

BUSINESS TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

HOME ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

HOME TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

PERSON RESPONSIBLE FOR CHILD

LAST NAME

 

MIDDLE

FIRST

HOME TELEPHONE

BUSINESS TELEPHONE

 

 

 

 

 

 

(

)

(

)

 

 

 

 

 

 

 

 

 

 

ADDITIONAL PERSONS WHO MAY BE CALLED IN AN EMERGENCY

NAME

ADDRESS

TELEPHONE

RELATIONSHIP

PHYSICIAN OR DENTIST TO BE CALLED IN AN EMERGENCY

PHYSICIAN

 

ADDRESS

MEDICAL PLAN AND NUMBER

TELEPHONE

 

 

 

 

(

)

 

 

 

 

 

DENTIST

 

ADDRESS

MEDICAL PLAN AND NUMBER

TELEPHONE

 

 

 

 

(

)

 

 

 

 

IF PHYSICIAN CANNOT BE REACHED, WHAT ACTION SHOULD BE TAKEN?

 

 

 

CALL EMERGENCY HOSPITAL

OTHER

EXPLAIN: ____________________________________________________________________________________________________________________

NAMES OF PERSONS AUTHORIZED TO TAKE CHILD FROM THE FACILITY

(CHILD WILL NOT BE ALLOWED TO LEAVE WITH ANY OTHER PERSON WITHOUT WRITTEN AUTHORIZATION FROM PARENT OR AUTHORIZED REPRESENTATIVE)

NAME

RELATIONSHIP

TIME CHILD WILL BE CALLED FOR

SIGNATURE OF PARENT/GUARDIAN OR AUTHORIZED REPRESENTATIVE

DATE

TO BE COMPLETED BY FACILITY DIRECTOR/ADMINISTRATOR/FAMILY CHILD CARE HOMES LICENSEE

DATE OF ADMISSION

LIC 700 (8/08)(CONFIDENTIAL)

DATE LEFT

File Breakdown

Fact Name Description
Form Purpose The LIC 700 form is designed for child care centers and family child care homes in California, ensuring that essential identification and emergency information is collected for each child.
Completion Responsibility This form must be completed by a parent or authorized representative of the child, providing necessary details such as the child's name and emergency contacts.
Emergency Contacts The form requires identifying persons who can be contacted in case of an emergency, including a child’s physician or dentist and other adults authorized to pick up the child.
Confidentiality The LIC 700 is marked as confidential, emphasizing the importance of protecting the child's personal information.
Governing Law This form is governed by California regulations under the Health and Safety Code, specifically pertaining to child care facilities.
Version Date The current version of the LIC 700 form is dated August 2008, indicating the need to refer to this specific version when submitting information.

Guide to Using Lic 700

The Lic 700 form must be carefully filled out to ensure accurate identification and emergency information for child care centers or family child care homes. Providing correct details helps facilitate communication in case of emergencies. Follow the steps below to complete the form.

  1. Obtain the form: Ensure you have the latest version of the Lic 700 form. You can typically find it on the California Department of Social Services website or request it from the child care facility.
  2. Child's Information: Fill in the child's name (last, middle, first), sex, telephone number, address (number, street, city, state, zip), and birthdate in the appropriate spaces.
  3. Father's/Guardian's Information: Enter the father’s, guardian’s, or father’s domestic partner’s name (last, middle, first), business telephone, home address (number, street, city, state, zip), and home telephone number.
  4. Mother's/Guardian's Information: Provide the mother’s, guardian’s, or mother’s domestic partner’s name (last, middle, first), business telephone, home address (number, street, city, state, zip), and home telephone number.
  5. Responsible Person: Fill in the name (last, middle, first) of the person responsible for the child, along with their home telephone number and business telephone number.
  6. Emergency Contacts: List additional persons (name, address, telephone, relationship) who may be called in an emergency.
  7. Emergency Medical Contacts: Enter the name of the physician or dentist to be contacted in an emergency, along with their address, medical plan and number, and telephone number.
  8. Emergency Action: Indicate what action should be taken if the physician cannot be reached by selecting either "Call Emergency Hospital" or "Other," and provide an explanation if necessary.
  9. Authorized Persons: List names and relationships of persons authorized to take the child from the facility, noting the times the child will be called for them.
  10. Signature: The parent, guardian, or authorized representative must sign and date the form at the designated space.

Get Answers on Lic 700

  1. What is the purpose of the LIC 700 form?

    The LIC 700 form is designed to collect crucial identification and emergency information for children enrolled in child care centers and family child care homes in California. This information ensures that child care providers have access to essential details in case of emergencies, allowing for swift and effective action when needed.

  2. Who needs to complete the LIC 700 form?

    This form must be completed by a parent or authorized representative of the child. It is essential for anyone who wishes to enroll their child in a licensed child care program within California.

  3. What information is required on the LIC 700 form?

    The form requests a variety of information, including:

    • Child's name and birthdate
    • Parent or guardian contact information
    • Emergency contacts
    • Primary physician and dentist details
    • Names of individuals authorized to pick up the child
  4. Is the information on the LIC 700 form confidential?

    Yes, the LIC 700 form is considered confidential. The information collected is intended solely for the use of the child care facility and is protected under privacy laws. It should not be shared with unauthorized individuals.

  5. How often should the LIC 700 form be updated?

  6. What happens in case of an emergency?

    If an emergency arises and the child's physician or dentist cannot be reached, the form allows the caregiver to take specific actions. This typically includes transporting the child to a nearby emergency hospital or taking other necessary steps, as detailed in the parent's instructions on the form.

  7. Are there any consequences if the LIC 700 form is not completed?

    Failure to complete the LIC 700 form may result in the child not being allowed to participate in the child care program. Additionally, in emergencies, the lack of vital information might hinder timely medical intervention, potentially putting the child's health at risk.

  8. Can someone other than a parent complete the LIC 700 form?

    Yes, an authorized representative can complete the LIC 700 form on behalf of the parent. However, it is crucial that this individual has the necessary permissions and understands the child's specific needs and circumstances.

  9. Where do I submit the completed LIC 700 form?

    The completed LIC 700 form should be submitted to the child care facility where the child is being enrolled. The facility's director or administrator will review the form and maintain it in the child's file.

  10. Is there a fee associated with submitting the LIC 700 form?

    There is no fee for completing or submitting the LIC 700 form. It is a required document as part of the enrollment process, and its primary purpose is to ensure the safety and well-being of the child while in care.

Common mistakes

When filling out the Lic 700 form, many people accidentally make mistakes that can lead to delays or complications in the enrollment process. Here are seven common errors to watch out for:

First and foremost, forgetting to provide complete contact information can be problematic. Each section asking for names, telephone numbers, and addresses must be filled out thoroughly. Incomplete details make it hard for facilities to reach parents in emergencies. Double-check every entry to ensure no details are missing.

Another frequent mistake is omitting the child’s full name. This includes the first, middle, and last names. It might seem insignificant, but having the correct name is crucial for properly identifying your child in any system. Names must match official documents, so ensure there are no typos.

Some parents neglect to include emergency contacts or mistakenly list individuals who are unavailable. Always list multiple trusted contacts who can be reached in case of an emergency. This ensures that there will always be someone who can assist if needed.

Confusion regarding guardianship can also lead to errors. If the child has a guardian or a domestic partner involved, make sure their full names and contact information are clearly recorded. This is important not just for paperwork, but for ensuring the child’s safety.

Providing inconsistent information is another common slip-up. For example, if you list one address for the parent but a different one for a guardian, it creates unnecessary confusion. Consistency is key, so confirm that all information matches across the form.

Additionally, some parents overlook the section that designates those authorized to take the child from the facility. This can lead to uncomfortable situations where the child is unable to leave with a trusted individual. Be sure to list everyone who has permission to pick up the child, along with their relationship to the child.

Finally, failing to sign and date the form might seem trivial, but it is an essential step. Without a signature, the form is incomplete and cannot be processed. Ensure both the signature and date are included before submitting.

By avoiding these common pitfalls, parents and guardians can make the enrollment process smoother and ensure their child is cared for appropriately.

Documents used along the form

When working with the Lic 700 form, various additional documents may be required to ensure compliance with regulations and provide complete information regarding child care centers or family child care homes. Understanding these documents can streamline the process for parents and providers, creating a safer environment for children.

  • Licensure Application: This document initiates the process to obtain a license for operating a child care facility. It includes vital information about the applicant and the proposed operation.
  • Criminal Background Check Form: This form must be completed to ensure the safety of children. It helps verify that caregivers do not have a disqualifying criminal history.
  • Health and Immunization Records: These records are essential to confirm that children are up to date on vaccinations and meet health requirements for attendance in a child care setting.
  • Emergency Contact List: This document outlines additional contacts who can be reached in case of emergencies, ensuring that staff have multiple options to notify family members.
  • Parent Handbooks: These documents provide parents with information on the policies, procedures, and expectations of the child care center, fostering communication between providers and families.
  • Child’s Daily Schedule: This outline details the daily activities and routines for children, helping parents understand what their child will experience each day.
  • Incident Report Forms: These forms are used to document any accidents or unusual incidents that occur during care. They provide a record for accountability and transparency.
  • Enrollment Agreement: This contract between the child care provider and parents includes terms of service, payment policies, and expectations. It serves as a formal agreement outlining responsibilities.
  • Permission Slips: For activities outside the facility, these slips are required to ensure that parents have given consent for their child to participate in special outings or excursions.
  • Medical Release Forms: These forms grant permission to seek emergency medical care for a child if the parent or guardian cannot be contacted, ensuring that prompt action can be taken when necessary.

Utilizing these forms alongside the Lic 700 ensures that every aspect of child care is covered comprehensively. By being aware of these documents, parents and providers can contribute to creating a secure and nurturing environment for children.

Similar forms

  • Lic 701 Form: This form collects similar information about the child as the Lic 700. It includes emergency contact details, parent or guardian information, and authorized persons for pickup. The focus is on child safety and ensuring proper identification.

  • Lic 702 Form: Like the Lic 700, this form provides emergency details but emphasizes health history and allergies. This information helps caregivers prepare for health-related emergencies involving the child.

  • Lic 703 Form: This document also seeks contact information and emergency procedures. It includes details about additional adults who may be authorized to pick up the child, ensuring proper authorization is in place.

  • Lic 704 Form: This form focuses on medical consents for the child. It seeks information on caregivers and specifies actions to take in case of emergencies, much like the Lic 700.

  • Lic 705 Form: Similar to the Lic 700, the Lic 705 collects information relevant to the child's life at a childcare center. This includes details about parent contacts and emergency protocols.

  • Lic 706 Form: This form gathers similar identification information. It is used primarily for child summer camps and day programs, highlighting the need for safety and emergency readiness.

  • Lic 707 Form: This document helps maintain up-to-date emergency information. It addresses who can pick up the child, similar to the provisions in the Lic 700.

  • Lic 708 Form: Sharing similarities with the Lic 700, this form is focused on transportation permissions. It covers consent for the child to be transported by specific individuals or services.

  • Lic 709 Form: This form helps summarize emergency contact information and health details. Its purpose aligns with the Lic 700's focus on safety and emergency preparedness.

Dos and Don'ts

When filling out the Lic 700 form, there are specific actions that can facilitate a smoother process. Understanding what to do and what to avoid will help ensure that your submission is complete and accurate.

  • Do
  • Do ensure that names are spelled correctly, especially for the child and guardians.
  • Do fill in emergency contacts to ensure that help can be reached if necessary.
  • Do double-check that the contact numbers listed are current and accessible.
  • Don't leave any sections blank; this can delay processing or lead to misunderstandings.
  • Don't use nicknames; always provide the legal names of individuals involved.
  • Don't forget to sign and date the form before submitting it.

Misconceptions

The Lic 700 form, a vital document for child care centers and family child care homes in California, often sparks confusion. Here are four common misconceptions about this important form:

  • 1. The Lic 700 form is only for emergency contacts. While it does collect emergency contact information, the form also gathers essential details about the child's background and health, ensuring that caregivers have comprehensive information at their fingertips.
  • 2. Parents must fill out the Lic 700 form in person. Many parents believe they must be physically present to complete this form. In reality, authorized representatives can fill it out on behalf of the parents, providing flexibility for busy families.
  • 3. Outdated versions of the Lic 700 form are acceptable. Some think that using older versions is permissible. However, it's important to use the most current version of the Lic 700 form to ensure compliance with state regulations and to provide accurate information.
  • 4. The information on the Lic 700 form is public. There is a misconception that the details collected are accessible to anyone. In truth, this information is confidential and protected, designed specifically to maintain the privacy of the child and family.

Understanding the purpose and requirements of the Lic 700 form can empower parents and caregivers alike. Clear communication and accurate information help promote safe and responsible child care environments.

Key takeaways

Here are some key takeaways about filling out and using the Lic 700 form for childcare centers and family childcare homes in California:

  • The Lic 700 form is crucial for providing identification and emergency information about your child.
  • Ensure you fill in the child's full name, including last, middle, and first names accurately.
  • It is important to include the telephone number and address of the child’s home.
  • The form requires information about both parents or guardians, including their names and contact numbers.
  • List a person responsible for the child in addition to the parents; this person should be easily reachable.
  • Fill in the names and contact details of individuals authorized to pick up your child from the facility.
  • Provide your child's physician and dentist information, including addresses and telephone numbers.
  • In case of an emergency, clearly state what actions should be taken if the physician cannot be reached.
  • Remember to sign and date the form at the bottom to confirm the information is accurate and complete.
  • Keep a copy for your own records and provide the completed form to the childcare facility.