Family Child Care Application PDF Details

If you are looking for a family child care application, look no further! This document is perfect for anyone who wants to open their own home child care. The form includes sections on contact information, child care services provided, parental consent forms, and more.

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QuestionAnswer
Form NameFamily Child Care Application
Form Length2 pages
Fillable?Yes
Fillable fields2
Avg. time to fill out54 sec
Other namesca floor plan, california lic 999a form, lic999, sketch floor plan care

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

FACILITY SKETCH (Floor Plan) - Family Child Care Home

Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms such as the kitchen, bath, living room, etc. Please identify areas which will be “off limits” to children. Door and window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x 12). Keep close to scale. Use the space below. See back for yard sketch.

FACILITY NAME:

ADDRESS:

LIC 999A (2/05)

1

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

FACILITY SKETCH (Yard) - Family Child Care Home

The yard sketch should show all buildings in the yard including the home (with no detail), garage and storage building. Include walks, driveways, play area, fences, gates. Please identify areas which will be “off limits” to children. Show any potential hazardous areas such as pools, garbage storage, animal pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use the space below.

FACILITY NAME:

ADDRESS:

LIC 999A (2/05)

2

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