Lic 700 Form
Lic 700 Form - Responsible person or placement agency 3. State of california health and human services agency. Additional persons who may be called in an emergency. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date Social security number (optional) date of birth age sex 2. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that Ca dept of social services subject: California department of social services community care licensing division. State of california health and human services agency. State of california health and human services agency.
All facilities [except child care center/family child care home completes lic 700] 1. Additional persons who may be called in an emergency. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date Web lic 700 (9/07)(confidential) title: Identification and emergency information child care centers created date: Lic 700 (hm) (8/08) (confidential) All facilities [except child care center/family child care home completes lic 700] person(s) responsible for financial affairs, payment for care, legal guardian, if any other persons to be notified in emergency emergency hospitalization plan other required information 1.
Ca dept of social services subject: Name of client or child. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date Web lic 700 (9/07)(confidential) title: Identification and emergency information child care centers/family child care homes.
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All facilities [except child care center/family child care home completes lic 700] 1. State of california health and human services agency. Additional persons who may be called in an emergency. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date
All facilities [except child care center/family child care home completes lic 700] person(s) responsible for financial affairs, payment for care, legal guardian, if any other persons to be notified in emergency emergency hospitalization plan other required information 1. Identification and emergency information child care centers/family child care homes. Additional persons who may be called in an emergency. California department of social services community care licensing division. Name of client or child.
Identification and emergency information child care centers created date: State of california health and human services agency. All facilities [except child care center/family child care home completes lic 700] person(s) responsible for financial affairs, payment for care, legal guardian, if any other persons to be notified in emergency emergency hospitalization plan other required information 1. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date
Web Lic 700 (10/19) (Confidential) Page 2 Of 2 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 Picked Up Signature Of Parent/Guardian Or Authorized Representative Date
All facilities [except child care center/family child care home completes lic 700] person(s) responsible for financial affairs, payment for care, legal guardian, if any other persons to be notified in emergency emergency hospitalization plan other required information 1. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that State of california health and human services agency. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date
Web Lic 700 (10/19) (Confidential) Page 2 Of 2 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 Picked Up Signature Of Parent/Guardian Or Authorized Representative Date
Additional persons who may be called in an emergency. Lic 700 (hm) (8/08) (confidential) Name of client or child 2. Social security number (optional) date of birth age sex 2.
Identification And Emergency Information Child Care Centers/Family Child Care Homes.
3825, 3510 and neft combined for matuirty claim 3825 discharge form maturity claim 5180. Form lic700 is often used in family child care home, child care center, california department of social services. California department of social services community care licensing division. Identification and emergency information child care centers/family child care homes.
Web Lic 700 (9/07)(Confidential) Title:
Web lic 700 (8/08)(confidential) title: Receive, from the licensee, the caregiver background check process form. To be completed by parent or authorized representative. Ca dept of social services subject: