Form Lic 995 PDF Details

Understanding the LIC 995 form is essential for every parent or guardian who has their child enrolled in a child care center in California. This document, issued by the California Department of Social Services' Community Care Licensing Division, outlines the comprehensive rights parents and authorized representatives hold concerning the care of their children. These rights include unfettered access to inspect the child care center without prior notice, the ability to file complaints against the facility, and the right to examine reports of licensing visits and substantiated complaints made within the last three years. Moreover, the form protects individuals from discrimination or retaliation when exercising these rights and allows for the request of barring certain parents from visiting or taking a child from the center, with the proper court documentation. Furthermore, it mandates that the child care licensee provides the contact information of the local licensing office, informs parents upon request about any adult with a criminal record exemption associated with the center, and supplies the Caregiver Background Check Process form. It also incorporates a section highlighting the legal limitations on parental access based on behavior that could pose a risk to children in care. Ultimately, the LIC 995 form empowers parents and guardians by ensuring they are fully informed of their rights and the measures in place to safeguard the well-being of their children in child care settings.

QuestionAnswer
Form NameForm Lic 995
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCaregiver, Acknowledgement, california, LICENSING

Form Preview Example

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING DIVISION

CHILD CARE CENTER

NOTIFICATION OF PARENTS’ RIGHTS

PARENTS’ RIGHTS

As a Parent/Authorized Representative, you have the right to:

1.Enter and inspect the child care center without advance notice whenever children are in care.

2.File a complaint against the licensee with the licensing office and review the licensee’s public file kept by the licensing office.

3.Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years.

4.Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.

5.Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order.

6.Receive from the licensee the name, address and telephone number of the local licensing office.

Licensing Office Name:

_________________________________________________

Licensing Office Address:

_________________________________________________

Licensing Office Telephone #:

_________________________________________________

7.Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office.

8.Receive, from the licensee, the Caregiver Background Check Process form.

NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE POSES A RISK TO CHILDREN IN CARE.

For the Department of Justice “Registered Sex Offender”database, go to www.meganslaw.ca.gov

LIC 995 (9/08)(Detach Here - Give Upper Portion to Parents)

AC K N OW L E D G E M E N T O F N OT I F I C AT I O N O F PA R E N T S ’ R I G H T S

(Parent/Authorized Representative Signature Required)

I, the parent/authorized representative of ________________________________________________, have

received a copy of the “CHILD CARE CENTER NOTIFICATION OF PARENTS’ RIGHTS” and the CAREGIVER BACKGROUND CHECK PROCESS form from the licensee.

_____________________________________

Name of Child Care Center

______________________________________________

__________________

Signature (Parent/Authorized Representative)

Date

NOTE: This Acknowledgement must be kept in child’s file and a copy of the Notification given to parent/authorized representative.

For the Department of Justice “Registered Sex Offender”database go to www.meganslaw.ca.gov

LIC 995 (9/08)

How to Edit Form Lic 995 Online for Free

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Jot down the data in the Name of Child Care Center, Signature ParentAuthorized, Date, NOTE This Acknowledgement must be, parentauthorized representative, For the Department of Justice, and LIC area.

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