Form BCAL-3731 PDF Details

Are you familiar with Form BCAL-3731? If not, you should be. This form collects child information records and is essential for childcare centers to maintain such records. This blog post will closely examine what Form BCAL-3731 is used for and how to complete it correctly. We'll also provide a few tips on how to reduce the amount of taxes your business pays.

This page includes details about Form BCAL-3731. You may want to learn its length, the typical time to complete the form, the fields you will need to fill in, and so on.

QuestionAnswer
Form Name Form Bcal 3731
Form Length 1 pages
Fillable? Yes
Fillable fields 77
Avg. time to fill out 15 min 39 sec
Other names bcal 3731, state of michigan child information record, bcal 3731 form, bcal3731

Form Preview Example

CHILD INFORMATION RECORD

State of Michigan Department of Human Services - Bureau of Children and Adult Licensing

Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank fi eld, a line through a fi eld or “N/A” are not acceptable responses.

For Provider

Date of Admission

 

Date of Discharge

 

 

 

 

 

 

Use Only:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Child (Last, First, Middle Initial)

 

 

 

 

 

 

Child’s Date of Birth

 

 

 

 

 

 

 

 

Address (Number and Street, Building/Apartment Number)

City

 

 

State

Zip Code

 

 

 

 

 

 

 

Father/Legal Guardian’s Name

Home Phone

Mother/Legal Guardian’s Name

Home Phone

 

 

 

(

)

 

 

 

 

(

)

 

 

 

 

 

Home Address (if not child’s address)

Cell Phone

Home Address (if not child’s address)

Cell Phone

 

 

 

(

)

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

City

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

Email Address (optional)

 

 

Email Address (optional)

 

 

 

 

 

 

 

 

 

Employer Name

 

 

Work Phone

Employer Name

Work Phone

 

 

 

(

)

 

 

 

 

(

)

 

 

 

 

 

 

 

Name of Child’s Physician or Health Clinic

 

 

Physician’s or Health Clinic’s Phone Number

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Preferred for Emergency Treatment (optional)

Allergies, Special Needs and Special Instructions (Attach additional sheets, if necessary.)

BCAL-3731 (Rev. 7-12) Previous editions 9-09, 3-08, 10-07, & 1-06 may be used until 12/31/13.

See Reverse Side

Emergency Contact & Release of Child: List all individuals,including parents/legal guardians, in order of preference, to be contacted in an emergency. If possible, include at least one person other than the parents/legal guardians to be contacted in an emergency and to whom the child can be released. The second phone number column can be left blank. (If more individuals, attach additional sheets.)

1.

()

()

2.

()

()

3.

()

()

Release of Child Only: List all individuals, other than the parents/legal guardians, to whom the child may be released. (If more individuals, attach additional sheets.)

1.

3.

(

)

2.

(

)

(

)

4.

(

)

 

 

 

 

 

I give permission to

, licensed by the Department of Human Services

(Provider’s Name)

to secure emergency medical and/or emergency surgical treatment for the above named minor child while in care.

Signature of Parent or Guardian

Date Signed

 

 

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS offi ce in your area.

AUTHORITY: 1973 PA 116

COMPLETION: Required

PENALTY: Rule Violation Citation.

BCAL-3731 (Rev. 7-12) Previous editions 9-09,3-08, 10-07, & 1-06 may be used until 12/31/13.

How to Edit Form BCAL-3731 Online for Free

It shouldn’t be difficult to obtain bcal 3731 writable applying our PDF editor. This is the way you will be able conveniently develop your document.

Step 1: You can hit the orange "Get Form Now" button at the top of this webpage.

Step 2: After you've entered the editing page bcal 3731 writable, you'll be able to notice all of the options readily available for your file inside the top menu.

Complete the bc, al 3731 writable PDF and provide the material for each section:

step 1 to writing bcal3731 fillable

Fill in the Parent, Legal, Guardian, Initials Signature, of, Parent, or, Guardian Date, Signed Date, Card, Reviewed Parent, or, Legal, Guardian, Initials Date, Card, Reviewed Parent, or, Legal, Guardian, Initials Date, Card, Reviewed Parent, or, Legal, Guardian, Initials Date, Card, Reviewed Parent, or, Legal, Guardian, Initials and BC, AL, Rev, Previous, edition, maybe, used areas with any data that can be asked by the software.

Entering details in bcal3731 fillable stage 2

Step 3: Select the "Done" button. Now you can export your PDF form to your gadget. In addition, you can easily send it by means of email.

Step 4: Generate copies of the document. This can protect you from possible difficulties. We cannot look at or distribute your data, so be sure it will be protected.

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