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Receive, from the licensee, the caregiver background check process form. Physician's checklist (child care facilities) To be completed by parent. Additional persons who may be called in an emergency. Web lic 700 (10/19) (confidential) page.

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State of california health and human services agency. California department of social services community care licensing division. State of california health and human services agency. California department of social services community care licensing division. All.

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California department of social services community care licensing division. Name of client or child 2. Identification and emergency information child care centers/family child care homes. California department of social services community care licensing division. State.

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Web lic 700 (10/19) (confidential) page 2 of 2 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.

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California department of social services community care licensing division. All facilities [except child care center/family child care home completes lic 700] person(s) responsible for financial affairs, payment for care, legal guardian, if any other persons.

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Receive, from the licensee, the caregiver background check process form. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that Name of client or child. Web.

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Identification and emergency information child care centers created date: Identification and emergency information child care centers/family child care homes. Receive, from the licensee, the caregiver background check process form. Lic 700 (hm) (8/08) (confidential) Signature.

Responsible person or placement agency 3. Lic 700 (hm) (8/08) (confidential) Web tus niam txiv/neeg saib xyuas lossis tus muaj cai sawv cev kos npe hnub tim. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date

Physician's checklist (child care facilities) Identification and emergency information child care centers/family child care homes. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that

California Department Of Social Services Community Care Licensing Division.

Receive, from the licensee, the caregiver background check process form. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date California department of social services community care licensing division. Web lic 700 (9/07)(confidential) title:

Additional Persons Who May Be Called In An Emergency.

Responsible person or placement agency. Lic 700 (hm) (8/08) (confidential) State of california health and human services agency. Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date

All Facilities [Except Child Care Center/Family Child Care Home Completes Lic 700] Person(S) Responsible For Financial Affairs, Payment For Care, Legal Guardian, If Any Other Persons To Be Notified In Emergency Emergency Hospitalization Plan Other Required Information 1.

Ca dept of social services subject: Web lic 700 (10/19) (confidential) page 2 of 2 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 picked up signature of parent/guardian or authorized representative date California department of social services. Name of client or child 2.

All Facilities [Except Child Care Center/Family Child Care Home Completes Lic 700] 1.

Web lic 700 (8/08)(confidential) title: Responsible person or placement agency 3. Web tus niam txiv/neeg saib xyuas lossis tus muaj cai sawv cev kos npe hnub tim. Identification and emergency information child care centers/family child care homes.

California department of social services community care licensing division. California department of social services. 3825, 3510 and neft combined for matuirty claim 3825 discharge form maturity claim 5180. Be informed, by the licensee, that the facility has or does not have liability insurance (or a bond) that Web lic 700 (eng/sp) (5/00)(confidential) created date: