Lic 700 Form PDF Details

In navigating the multifaceted landscape of child care services within California, the LIC 700 form emerges as a critical document, facilitating a smooth operational flow between caregivers and families. Drafted by the California Department of Social Services, particularly by the Community Care Licensing Division, this form serves as a nexus of identification and emergency information for children receiving care in both Child Care Centers and Family Child Care Homes. The comprehensive nature of the LIC 700 is evident in its meticulous requirement for details encompassing the child’s personal information, from name and birthdate to a detailed address, thereby ensuring a safeguarding framework is in place. Moreover, it extends to encompass the vital contact details of parents or guardians, including both home and business telephone numbers, which are imperative for ensuring a reliable communication channel. The form further delves into designating responsible individuals in cases of emergencies, alongside detailing additional contacts, thereby establishing a robust safety net around the child. In prescribing actions to be taken if the primary physician cannot be reached and delineating authorized individuals for the child's pickup, the LIC 700 underscores the paramount importance of preparedness and clarity in child care scenarios. This documentary requirement, thus, not only epitomizes thoroughness but also mirrors the state’s commitment to child welfare, substantiating its role as an indispensable tool in the realm of child care services management in California.

QuestionAnswer
Form Name Lic 700 Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names lic 700 form no download needed, lic700, identification and emergency information lic 700, lic 700 form english

Form Preview 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

How to Edit LIC 700 Form Online for Free

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Step 1: Look for the button "Get Form Here" on the following site and hit it.

Step 2: At the moment, you can change your lic700. Our multifunctional toolbar lets you insert, delete, customize, highlight, and also undertake other sorts of commands to the content material and areas within the file.

The next parts are what you are going to complete to have the prepared PDF file.

example of gaps in lic 700 form no download needed

The system will expect you to complete the DENTIST, ADDRESS, MEDICAL PLAN AND NUMBER, TELEPHONE, IF PHYSICIAN CANNOT BE REACHED, CALL EMERGENCY HOSPITAL, OTHER, EXPLAIN, NAMES OF PERSONS AUTHORIZED TO, NAME, RELATIONSHIP, TIME CHILD WILL BE CALLED FOR, SIGNATURE OF PARENTGUARDIAN OR, DATE, and DATE OF ADMISSION field.

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