Child Info Record Details

The Bcal 3731 form is a document that you fill out in order to apply for the British Columbia Adult Learners' Permit. The following are some of the eligibility requirements: -Learner must be at least 16 years old -Must have completed an approved Driver Education course or program -Must have held a valid driver's license in any other country, province, state, territory or district for at least 3 consecutive months and not had their privilege suspended, revoked or cancelled during that time period.

Here is the information relating to the file you were seeking to complete. It can tell you the length of time you'll need to finish bcal 3731 form, exactly what fields you will have to fill in, and so forth.

QuestionAnswer
Form NameBcal 3731 Form
Form Length1 pages
Fillable?Yes
Fillable fields75
Avg. time to fill out15 min 15 sec
Other namesmichigan child information record, child information, child information pdf, child information record

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 Bcal 3731 Form

The PDF editor was developed to be as easy as possible. Since you try out these actions, the procedure for preparing the child information record file is going to be easy.

Step 1: Choose the button "Get Form Here" and press it.

Step 2: The document editing page is right now open. You can include information or change existing information.

You should provide the following information to prepare the child information record PDF:

how to bcal 3731 empty fields to fill out

Note the necessary information in Allergies, BCAL-3731 (Rev, See Reverse Side, Emergency Contact & Release of, and Release of Child Only: List all area.

how to bcal 3731 Allergies, BCAL-3731 (Rev, See Reverse Side, Emergency Contact & Release of, and Release of Child Only: List all fields to complete

Type in any details you may need in the field I give permission to, (Provider’s Name), to secure emergency medical and/or, 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), AUTHORITY: 1973 PA 116 COMPLETION:, and BCAL-3731 (Rev.

Filling out how to bcal 3731 step 3

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