Forms for Child Care Providers

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The documents listed on the Child Care Productions site are available as PDF (portable document format) files pdf: . To be able to read these files, please download a free copy of Adobe Acrobat Reader.

Forms needed for Family Day Care providers:

    LIC 282 Affidavit Regarding Liability Insurance for Family Day Care Home (Required if provider does not have Family Child Care Liability Insurance)

    LIC 9150 Parent’s Rights (required)

    LIC 508 Criminal Record Statement

    LIC 613A Personal Rights (required)

    LIC 627 Consent for Emergency Medical Treatment (required)

    LIC 700 Identification and Emergency Information (required)

    LIC 702 Child’s Preadmission Health History (required)

    LIC 995 Parent’s Right’s (required)

    LIC 9040 Child Care Facility Roster (required)

    LIC 9052 NOTICE Employee Rights (required if a large facility)

Pamphlets for parents/guardians(Need to be given when child is enrolled)

    PUB 72 Family Child Care- What are Parent’s Responsibilities

    PUB 270 Never Shake a Baby

    PUB 300 Reduce the Risk of Sudden Infant Death Syndrome


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