Lic 700 Form Details

Are you looking for a way to make your business more professional and organized? If so, you may want to consider using the Lic 700 form. This form is used to help businesses keep track of their employees' licenses and permits. By using the Lic 700 form, you can ensure that your business is in compliance with all licensing requirements. Additionally, using the Lic 700 form can help you keep track of employee expiration dates and renewals.

This article includes specifics of lic 700 form. You may want to study it just before filling in the form.

QuestionAnswer
Form NameLic 700 Form
Form Length1 pages
Fillable?Yes
Fillable fields85
Avg. time to fill out17 min 19 sec
Other namesidentification and emergency information lic 700, lic 700 form, lic 700 form english, lic700

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

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