To Be Completed by Parent or Authorized Representative
(Child will not be allowed to leave with any other person without written authorized from parent or authorized representative)
Note: Regulation Section 101221 requires the following information be on file.
From to at daily while in attendance.
MEDICATION CHART Staff Documentation of Medicine Administration
Upon completion, return medicine to parent or destroy, and place form in child's record.
Child Care Centers Or Family Child Care Homes
AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR . THIS CARE MAY BE GIVEN UNDER NAME WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE CHILD NAMED ABOVE.
As a Parent/Authorized Representative, you have the right to:
NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE FAMILY CHILDCARE HOME 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
(Parent/Authorized Representative Signature Required)
I, the parent/authorized representative of have received a copy of the "FAMILY CHILD CARE HOME NOTIFICATION OF PARENTS' RIGHTS", the CAREGIVER BACKGROUND CHECK PROCESS and the FAMILY CHILD CARE CONSUMER AWARENESS INFORMATION form from the licensee.
(Name of Family Child Care Home)
NOTE: This Acknowledgement must be kept in child's file and a copy of the Notification given to the parent/authorized representative.
For the Department of Justice “Registered Sex Offender” database, go to www.meganslaw.ca.gov
CAREGIVER BACKGROUND CHECK PROCESS CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
The California Department of Social Services works to protect the safety of children in child care by licensing child care centers and family child care homes. Our highest priority is to be sure that children are in safe and healthy child care settings. California law requires a background check for any adult who owns, lives in, or works in a licensed child care home or center. Each of these adults must submit fingerprints so that a background check can be done to see if they have any history of crime. If we find that a person has been convicted of a crime other than a minor traffic violation or a marijuana-related offense covered by the marijuana reform legislation codified at Health and Safety Code sections 11361.5 and 11361.7, he/she cannot work or live in the licensed child care home or center unless approved by the Department. This approval is called an exemption.
A person convicted of a crime such as murder, rape, torture, kidnapping, crimes of sexual violence or molestation against children cannot by Law be given an exemption that would allow them to own,live in or work in a licensed child care home or center. If the crime was a felony or a serious misdemeanor, the person must leave the facility while the request is being reviewed. If the crime is less serious, he/she may be allowed to remain in the licensed child care home or center while the exemption request is being reviewed.
How the Exemption Request is Reviewed
We request information from police departments, the FBI and the courts about the person's record.We consider the type of crime, how many crimes there were, how long ago the crime happened and whether the person has been honest in what they told us.
The person who needs the exemption must provide information about:
The person also gives us reference letters from people who aren't related to them who know about their history and their life now.
We look at all these things very carefully in making our decision on exemptions. By law this information cannot be shared with the public.
How to Obtain More Information
As a parent or authorized representative of a child in licensed child care, you have the right to ask the licensed child care home or center whether anyone working or living there has an exemption. If you request this information, and there is a person with an exemption, the child care home or center must tell you the person's name and how he or she is involved with the home or center and give you the name, address, and telephone number of the local licensing office. You may also get the person's name by contacting the local licensing office. You may find the address and phone number on our website. The website address is http://ccld.ca.gov/cgntact.htm.
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)
I am 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 sixy ears 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 years old, and no more than three infants are in care.
706 W. Lamark Dr., Anaheim, CA 92802
(PRINT FACILITY ADDRESS)
Additional Children in Care
I, , acknowledge receipt of the notification that this Small Family Child Care Home may be providing care for more than six and up to eight children, or that this Large Family Child Care Home may be providing care for more than 12 and up to 14 children in accordance with Health and Safety Code Sections 1597.44 and 1597.465.
Maintain the completed and signed bottom half of this form in the child's record and provide the completed top half of this form to the child's parent or authorized representative.
CHILD CARE FACILITIES
This form may be used to show compliance with Health and Safety Code Section 1596.798 before a child care licensee or staff person administers inhaled medication to a child in care. A copy of the completed form should be filed in the child's record and in the personnel file. A separate form must be filled out for each person who administers inhaled medication to the child.
I, , give my consent for Edith Gates/Happy Hearts Preschool Child Care, who work(s) at 706 W. Lamark Dr., Anaheim, CA 92802, to administer inhaled medication to my child, and to contact my child's health care provider.
In addition, I certify that I have personally instructed the above-named licensee or staff person on how to administer inhaled medication to my child.
I have also provided the Child care facility with written instructions from my child's physician, or from a health care provider working under the supervision of my child's physician (for example, a physician's assistant, nurse practitioner or registered nurse). These instructions include:
Family Child Care (FCC) is provided by the home of a licensed provider for up to eight children with one adult or up to 14 children with one adult and one assistant. FCC homes provide a home like setting. Making sure the the licensed FCC homes are providing safe care is the job of the licensing agency, the parents and the provider.
HEALTH and SAFETY CHECKLIST
You should check for basic health and safet practices in the home. You FCC Provider, by state law and regulation, must do the following:
WHAT SHOULD THE FAMILY CHILD CARE HOME PROVIDE?
You should get answears to these questions before placing you child in the home:
DISCUSS THE FOLLOWING WITH THE PROVIDER:
GOOD CHILD CARE INCLUDES THESE THINGS:
The California Department of Social Services licenses home to provide child care, and wants you to understand the licensing laws and the ways in which you can check the quality of care you child receives.
WHAT SHOULD PARENTS DO?
PARENTS OF BABIES SHOULD ENSURE THAT:
HOW TO FILE A COMPLAINT ABOUT A FAMILY CHILD CARE HOME
WHEN YOU REPORT SUSPECTED VIOLATIONS YOU NOT ONLY PROTECT YOUR CHILD BUT ALSO PERFORM A SERVICE TO YOUR COMMUNITY.
WHAT THE LICENSING AGENCY DOES