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The Bcal 3731 form plays a critical role in the care and protection of children within the State of Michigan. It is designed by the Department of Human Services to gather essential information about a child, ensuring that caregivers have the necessary details at their fingertips. Importantly, the form includes space for personal information about the child and their legal guardians, such as names, contact information, and addresses. It also emphasizes the importance of emergency preparedness by requiring that emergency contacts be listed in order of preference, ensuring prompt and effective communication in times of need. Additionally, the Bcal 3731 form allows parents or guardians to specify any allergies, special needs, or instructions that could be critical for the child's well-being. It contains a section for granting permission for emergency medical treatment, which can be vital in urgent situations. Compliance with the instructions on the form is crucial, as incomplete or improperly filled forms may hinder timely care. By facilitating the collection of comprehensive information, the Bcal 3731 form underpins the commitment of the Michigan Department of Human Services to safeguard children and supports the responsibilities of child care providers in delivering safe and informed care.

Bcal 3731 Example

CHILD INFORMATION RECORD

State of Michigan - Department of Licensing and Regulatory Affairs - Child Care Licensing

Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank field, a line through a field or “N/A” are not acceptable responses.

For Provider

Date of Admission

Use Only:

 

 

 

Date of Discharge

 

Name of Child (Last, First, Middle Initial)

 

 

 

 

 

Child’s Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Number and Street, Building/Apartment Number)

 

City

 

State

Zip Code

 

 

 

 

 

 

 

 

Parent/Legal Guardian’s Name

 

Home Phone

Parent/Legal Guardian’s Name (Optional)

Home Phone

 

 

 

(

)

 

 

 

(

)

 

 

 

 

 

 

 

 

Home Address (if not child’s address)

Cell Phone

Home Address (if not child’s address)

Cell Phone

 

 

 

(

)

 

 

 

(

)

 

City

State

Zip Code

City

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

Email Address (optional)

 

 

 

Email Address

 

 

 

 

 

 

 

 

 

Employer Name

 

Work Phone

Employer Name

Work Phone

 

 

 

(

)

 

 

 

(

)

 

Name of Child’s Physician or Health Clinic

 

 

Physician’s or Health Clinic’s Phone Number

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Preferred for Emergency Treatment (optional)

Allergies, Special Needs and Special Instructions (Attach additional sheets, if necessary.)

BCAL-3731 (Rev. 7-18) Previous edition 6-17 may be used.

See Reverse Side

Emergency Contact & Release of Child: List all individuals, including parents/legal guardians, in order of preference, to be contacted in an emergency. If possible, include at least one person other than the parents/legal guardians to be contacted in an emergency and to whom the child can be released. The second phone number column can be left blank. (If more individuals, attach additional sheets.)

1.

2.

3.

( )

( )

( )

( )

( )

( )

Release of Child Only: List all individuals, other than the parents/legal guardians, to whom the child may be released. (If more individuals, attach additional sheets.)

1.

3.

(

)

2.

(

)

(

)

4.

(

)

 

 

 

 

 

Parent/Legal Guardian Initials:

I give permission to ______________________________, licensed by the Department of Licensing and Regulatory Affairs to secure emergency

medical treatment for the above named minor child while in care.

I certify that I accurately completed this form and if anything changes, I will notify the provider by updating this form.

Signature of Parent or Guardian

Date Signed

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

Date Card Reviewed

Parent or Legal Guardian Initials

LARA is an equal opportunity employer/program.

AUTHORITY: 1973 PA 116

COMPLETION: Required

PENALTY: Rule Violation Citation.

BCAL-3731 (Rev. 7-18) Previous edition 6-17may be used.

Form Characteristics

Fact Name Fact Description
Governing Authority The BCAL 3731 form is governed by the Michigan Public Act 116 of 1973.
Purpose This form is used for documenting essential information about children in care.
Required Information All fields must be filled out, or entries such as "unknown" or "none" must be provided if applicable.
Inappropriate Responses A blank field, a line through a field, or "N/A" will not be accepted.
Emergency Contact At least one emergency contact must be someone other than the parents or legal guardians.
Health Information Details about the child's physician, emergency hospital preferences, and special needs must be documented.
Signature Requirement A parent or legal guardian must sign the form to authorize emergency medical treatments.
Non-Discrimination Clause The Department of Human Services will not discriminate based on various factors, including race and disability.

Guidelines on Utilizing Bcal 3731

Once you have gathered all necessary information, you can begin filling out the BCAL 3731 form. This form requires specific details about the child, their parents or legal guardians, and emergency contacts. Being thorough and accurate is important, as incomplete information may lead to issues in emergencies or during care procedures.

  1. Start with the top section labeled “Name of Child” and write the child’s last name, first name, and middle initial.
  2. Enter the child’s date of birth in the designated format.
  3. Fill in the address field with the child’s complete address, including the number, street, building/apartment number, city, state, and zip code.
  4. Provide the father’s or legal guardian’s name followed by their home phone number.
  5. Next, write the mother’s or legal guardian’s name and their home phone number.
  6. If the child does not reside at the same home address as the parent(s), include that address, along with both parents’ cell phone numbers.
  7. Include optional email addresses if desired.
  8. Detail the employer name and work phone numbers for both parents or guardians.
  9. Identify the child’s physician or health clinic and supply their phone number.
  10. If you have a preferred hospital for emergency treatment, fill in this optional field.
  11. List any known allergies, special needs, or special instructions for the child. Additional sheets can be attached if necessary.
  12. For emergency contacts, list individuals in order of preference to be contacted in case of an emergency, providing their names and phone numbers. Include at least one person not related to the child if possible. Attach additional sheets for more names if needed.
  13. For the release of the child, provide the names and phone numbers of individuals, other than the parents, who may be permitted to take the child. Additional sheets may also be attached for more individuals if necessary.
  14. Grant permission for the care provider to secure emergency medical or surgical treatment for the child by signing the form where indicated. Include the date signed.
  15. Finally, the parent or legal guardian must initial beside each date reviewed, indicating confirmation of the information provided.

What You Should Know About This Form

What is the Bcal 3731 form?

The Bcal 3731 form is a Child Information Record used by the State of Michigan Department of Human Services. This document is essential for collecting vital information about a child in care, such as their personal details, emergency contacts, and medical needs. Proper completion of this form is required to ensure that the child's safety and well-being are prioritized while they are under the care of a licensed provider.

Who needs to fill out the Bcal 3731 form?

The form should be completed by the parents or legal guardians of the child who is entering a child care program or service. It is crucial that all sections of the form are filled out accurately to guarantee that the childcare provider has all the necessary information to care for the child effectively.

What information must be provided on the Bcal 3731 form?

All requested information must be provided unless otherwise indicated. This includes the child's name, date of birth, address, and information about their parents or guardians. Additionally, details such as emergency contacts, medical information, and any allergies or special needs must also be included. Responses must be complete; a blank field or “N/A” is not acceptable.

What should I do if I do not know the answer to a question on the form?

If you do not know the answer to a particular question, you must write “unknown” in that section. It is important to provide as much information as possible, but when information is genuinely not available, this is the appropriate response.

Can I attach additional sheets if there is not enough space on the form?

Yes, if there is not enough space on the form for the required information, you can attach additional sheets. This is especially useful for providing detailed information about allergies, special needs, or additional emergency contacts.

What is the purpose of the Emergency Contact & Release of Child section?

This section allows you to list individuals who can be contacted in case of an emergency involving the child. It is recommended to include at least one person other than the parents or legal guardians. This ensures that caregivers have alternative contacts available should any urgent situations arise.

Is it necessary to provide an email address on the form?

Providing an email address on the Bcal 3731 form is optional. However, including it can facilitate communication between the childcare provider and the parents or guardians, which is particularly important for updates or emergencies.

What permission am I granting by signing the Bcal 3731 form?

By signing the form, you are granting permission to the licensed childcare provider to secure emergency medical or surgical treatment for your child while they are in their care. This is a crucial step in ensuring that your child can receive timely medical attention if needed.

What happens if the form is not completed correctly?

If the Bcal 3731 form is not completed correctly, it may lead to delays in your child’s admission to the care program or even prevent them from receiving the care needed. Additionally, incomplete information can compromise the safety and well-being of your child during an emergency situation.

Who can I contact if I have questions about filling out the Bcal 3731 form?

If you have questions about the Bcal 3731 form or need assistance in filling it out, you should reach out to the childcare provider or the relevant Department of Human Services office. They can provide guidance on how to complete the form accurately and ensure that you have all necessary information at hand.

Common mistakes

Filling out the Bcal 3731 form can seem straightforward, but there are common pitfalls that applicants often encounter. One major mistake is leaving fields blank. Every section requires an answer; if you don’t know the information, you must write “unknown” instead. Simply marking a field as blank, drawing a line through it, or entering “N/A” will lead to delays or rejections, so it’s essential to provide proper responses.

An additional oversight is providing vague or incomplete information. For instance, when listing contact numbers for emergency contacts, it’s crucial to include accurate phone numbers. Omitting an area code or listing a number that is no longer in use can compromise the form's effectiveness. Clarity matters. Double-check that all names, addresses, and phone numbers are spelled correctly and are current.

Failing to specify allergies or special needs can also create complications. This information is vital for ensuring the child’s health and safety. If the child has allergies or requires special attention, detailing these needs on the form not only fulfills the requirement but also helps caregivers respond appropriately in emergencies.

Moreover, many people neglect to sign and date the document. The signature of a parent or legal guardian is essential for granting permission for emergency medical treatment. Skipping this step could leave the form invalid and jeopardize the child’s access to necessary care.

Sometimes, applicants forget to provide information about themselves. It’s not enough to only fill out details about the child; parents or legal guardians should also provide contact information and employment details. This thoroughness helps establish a reliable line of communication in case any issues arise.

Another common error involves listing too many individuals without prioritizing them. The form requests contacts in order of preference, yet many applicants simply list names without an order. This can create confusion. Taking the time to rank these contacts makes it easier for caregivers to know who to reach first in an emergency.

It's also worth noting that people occasionally misuse the release section. The form specifically states to list only individuals other than parents or guardians for child release. Including a parent’s name can lead to complications in emergency situations, so it's essential to follow this instruction carefully.

Finally, failing to attach additional sheets when necessary is a frequent mistake. If there isn’t enough space to list multiple contacts or provide detailed information about special needs, adding an extra sheet can be beneficial. Just make sure that any attachments are correctly labeled and referenced in the main form.

Documents used along the form

When completing the BCAL 3731 form, there are additional documents that are often required or helpful. These documents provide crucial information and ensure that all necessary areas are addressed. Below is a list of important forms that may accompany the BCAL 3731.

  • Child Health Assessment Form: This document assesses the child’s physical health and any medical concerns. It may require a physician's signature.
  • Emergency Contacts List: A detailed list of individuals who should be contacted in case of an emergency involving the child, including their phone numbers and relationship to the child.
  • Child's Immunization Record: This record provides proof of the child’s vaccinations and is essential for ensuring the child's health requirements are met.
  • Authorization for Emergency Medical Treatment: This form grants permission for health professionals to provide emergency treatment if the parents or guardians are unavailable.
  • Release of Information Consent Form: This document allows the sharing of pertinent information between caregivers, medical providers, and educational staff as necessary for the child's welfare.
  • Child Behavior Assessment Form: Completed by caregivers, this form evaluates the child’s behavioral health, highlighting any special needs or considerations.
  • Special Needs Documentation: If applicable, this supports any claims of disabilities or special needs, outlining necessary accommodations.
  • Parent or Guardian Agreement: This legal document outlines the responsibilities and expectations of the parents or guardians regarding the child's care.
  • Transportation Release Form: If the child will be transported by someone other than the parents, this form ensures that the child can be safely released to designated individuals.

Having these forms readily available not only assists with compliance but also helps create a safer and more organized environment for the child. Each document plays a vital role in fostering effective communication and planning among caregivers and health professionals.

Similar forms

  • BCAL-3700 - Child Placement Record: This document collects similar child information, including details of parents or guardians, to ensure proper placement and care.
  • BCAL-3712 - Child Service Plan: Like the Bcal 3731, this form outlines the services and supports needed for the child based on their specific needs.
  • BCAL-3720 - Provider Information Record: This document requires details about the provider, similar to the Bcal 3731's request for responsible adult information.
  • BCAL-3721 - Child Safety Assessment: This form focuses on assessing the safety of the child during care, paralleling the emergency contact and release section of the Bcal 3731.
  • BCAL-3723 - Medical History Record: Like the Bcal 3731, it gathers medical information and any special health instructions for the child.
  • BCAL-3740 - Incident Report Form: This document documents incidents involving children in care, similar to the Bcal 3731 by maintaining accountability of child safety.
  • BCAL-3741 - Emergency Care Plan: Similar in its purpose, this form outlines emergency procedures and contacts, reflecting the emergency information needed on the Bcal 3731.
  • BCAL-3742 - Behavioral Intervention Plan: This form creates strategies for responding to behavioral challenges, similar to how the Bcal 3731 outlines special needs and instructions for the child.

Dos and Don'ts

Do's and Don'ts for Filling Out the BCAL 3731 Form

  • Do provide all requested information completely.
  • Do use "unknown" or "none" if the information is not known or does not apply.
  • Do include emergency contacts beyond the parents or legal guardians.
  • Do ensure accuracy in all contact details provided.
  • Do double-check for spelling errors, especially in names and addresses.
  • Don't leave any field blank; blank fields are not acceptable.
  • Don't use "N/A" or draw lines through fields; these responses are not valid.
  • Don't forget to sign and date the form where indicated.
  • Don't hesitate to attach additional sheets if you require more space for information.

Misconceptions

There are several misconceptions surrounding the Bcal 3731 form, which can lead to confusion for those required to complete it. Here are six common misunderstandings:

  • The form can be submitted with blank fields. This is incorrect. Every requested piece of information must be provided. Leaving a field blank or marking “N/A” is not acceptable; all fields require a valid response such as “unknown” or “none.”
  • Emergency contact information is optional. In reality, it’s crucial to list emergency contacts for the child. The form specifically instructs that at least one contact other than the parents or guardians should be included, indicating its importance.
  • Only parents or legal guardians can sign the form. This is a misconception. While a parent or legal guardian's signature is necessary, anyone with legal authority over the child can complete the form, ensuring the child's well-being is prioritized.
  • Email addresses are required. This is not true. Providing email addresses is optional. Individuals are encouraged to include the information if possible, but it is not mandatory for form submission.
  • Outdated editions of the form cannot be used. Actually, previous editions, such as those from 2009 and earlier, are still acceptable until December 31, 2013, according to the instructions provided on the form.
  • All information must be filled out completely in one sitting. This misconception suggests that form completion must occur in one take. However, it is permissible to gather information over time and add it to the form as available.

Understanding these points can help ensure the correct completion of the Bcal 3731 form and aid in providing essential information for the child's care.

Key takeaways

When it comes to filling out the BCAL 3731 form, attention to detail is essential. Here are some key takeaways to keep in mind:

  • Provide Accurate Information: Make sure all fields are filled out completely. If something is unknown or not applicable, simply write “unknown” or “none.” Do not leave any fields blank or mark them as “N/A.”
  • Child's Details are Crucial: Include the child's full name, date of birth, and address. This helps in identifying the child and ensuring their details are correct.
  • Guardian Information: It’s important to provide the names and contact details of both parents or legal guardians. This includes home, cell, and work phone numbers, as well as email addresses if available.
  • Emergency Contacts: List emergency contacts in order of preference. Ensure that additional individuals can be contacted besides the parents. Their availability is key when urgency arises.
  • Release of Child: Clearly indicate who is authorized to pick up your child, apart from their parents or legal guardians. Again, clarity in this section is vital for your child's safety.
  • Medical Information: Provide details about the child's doctor, health clinic, and any allergies or special needs. Attach extra sheets if necessary to ensure all critical information is included.
  • Signatures Matter: Don’t forget to sign the form! A parent or guardian's signature is required to give permission for emergency medical treatment if needed.

Understanding these points can make the process smoother and ensure that every detail is accounted for, enhancing the well-being of the child in care.