Childs-File-Forms-and-Records - Forms and Records to Keep in Your Family Child Care Home

Sep 16, 2026

Uploaded by Rizky

Family child care home licensing guidance on which required forms and records must be maintained on file for pre-licensing review and ongoing compliance. Details the three-year retention requirement and specifies essential documents for children’s files, including parent notifications, consent forms for medical and nebulizer care, liability insurance affidavits, emergency identification, and caregiver background check materials. Includes California licensing form content and instructions for completing and providing facility and parent portions.

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CategoryForms

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Pages11

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FORMS/RECORDS TO KEEP IN YOUR FAMILY CHILD CARE HOME

CHILDREN'S FILES/RECORDS

Parent Notification - Additional Children in Care (LIC 9150)

Receipt of Parent Notification (Facility Copy)

Affidavit Regarding Liability Insurance for Family Child Care Home

# FORMS/RECORDS TO KEEP IN YOURFAMILY CHILD CARE HOME At your home inspection,your Licensing Program Analyst will also review all the required forms and information thatyou must keep on file in your home.Please do not submit any of these documents with the application.However,have them readily available at the time of your pre-licensing visit so your Licensing Program Analyst candiscuss them with you.Records must be kept for three years ## CHILDREN'S EORMS/RECORDS Children's files must contain the following documents/information: ● Parent Notification,Additional Children in Care (LIC 9150),if you plan to care for more than 6 childrenfor a Small Family Child Care Home,or more than 12 for a Large Family Child Care Home. ·Affidavit Regarding Liability Insurance (LIC 282)-This form is required to be signed by each parentof a child in care if you do not have either liability insurance or a bond. ·Consent for Medical Treatment(LIC 627)-This document gives you permission by the parent to seekemergency medica or dental care for their child if needed. ·Consent/Verification for Nebulizer Care (LIC 9166)-Before a child care licensee or staff person canadminister inhaled medication to a child in care,this form must be completed and filed in the child'srecord and in the personnel file.A separate form must be filled out for each person whoadministers inhaled medication to the child. ·Identification and Emergency Information (LIC 700)-This form must be kept for each child in careand identifies whom to call in an emergency. ·Notification of Parents'Rights (LIC 995A)-This form must be given to each parent at the time a childis accepted for care,along with the LIC 995E. ·Caregiver Background Check Process (LIC 995E)-This form must be given to each parent at thetime a child is accepted for care,along with the LIC 995A. ● Family Child Care Consumer Awareness Information (LIC 9212)-This form must be given tothe parents of each child in care ·California School Immunization Record(blue card)(PM 286)-For every infant,toddler,or preschoolage child admitted into a Family Child Care Home,the provider must maintain current immunizationrecords on the PM 286.It can be downloaded from the following website:http://www.dhs.ca.gov/publications/forms/immunization.htm but must be printed on blue paper onlv. ● Acknowledgement of Receipt of Licensing Reports (LIC 9224),if applicable. This information is requested by the Department of Social Services in compliance with Title 22,Division 12 of the California Code ofRegulations and Section 1596.70 et.Seg.of Health and Safety Code.Submission of the information is mandatory.The local licensing office isresponsible for maintaining the information.Access to this information will be provided unless prohibited by the Information Practice Act of1977.Certain authorized public and private agencies may have access to this information including the County Welfare Departments,Department of Justice,Regional Centers,the Department of Developmental Services and the Department of Mental Health. | STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENGY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
PARENT NOTIFICATION
ADDITIONAL CHILDREN IN CARE
As required by Health and Safety Code Sections 1597.44(c)and 1597.465(c),you are hereby
notified that:(Check one)
[]Iam licensed as a Small Family Child Care Home and may provide care for more than six
and up to eight children when one child is enrolled in and attending kindergarten
(including transitional kindergarten)or elementary school,and another child is at least six
years old,and no more than two infants are in care.
[] I am licensed as a Large Family Child Care Home,and with an assistant provider,may
provide care for more than 12 and up to 14 children when one child is enrolled in and
attending kindergarten (including transitional kindergarten)or elementary school,and
another child is at least six ye

FAQs

How long must forms and records be kept in a family child care home?

Records must be kept for three years.

What documents are required in each child’s file?

Required items include Parent Notification/Additional Children in Care (LIC 9150) when applicable, liability insurance affidavit (LIC 282) if no insurance or bond exists, consent for medical treatment (LIC 627), nebulizer care consent/verification (LIC 9166), identification and emergency information (LIC 700), parent rights notification (LIC 995A) and caregiver background check process (LIC 995E) when provided together.

When must the child care provider maintain California school immunization records (blue card)?

For every infant, toddler, or preschool-age child admitted to a Family Child Care Home, current immunization records on PM 286 must be maintained and printed on blue paper.

Sep 16, 2026

Uploaded by Rizky