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When it comes to ensuring the safety and well-being of children in care settings, the Lic 700 form plays a crucial role. This form collects vital identification and emergency information for each child, facilitating communication between parents, caregivers, and medical professionals. It includes essential details such as the child's name, sex, and contact information for parents or guardians. In addition, the form requires the listing of emergency contacts, ensuring that help is just a phone call away in urgent situations. Notably, it also identifies medical professionals, like a child's physician or dentist, who can be consulted in case of emergencies. The Lic 700 form empowers parents to establish authorized individuals who can take their child from the facility, providing an extra layer of security. Furthermore, it positions care providers to respond swiftly and effectively to any emergencies, making it an indispensable tool in child care centers and family child care homes throughout California.

Lic 700 Example

STATE OF CALIFORNIA

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

HEALTH AND HUMAN SERVICES AGENCY

COMMUNITY CARE LICENSING DIVISION

IDENTIFICATION AND EMERGENCY INFORMATION

CHILD CARE CENTERS/FAMILY CHILD CARE HOMES

To Be Completed by Parent or Authorized Representative

CHILD’S NAME

LAST

MIDDLE

FIRST

SEX

TELEPHONE

 

 

 

 

 

 

 

 

(

)

ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

BIRTHDATE

 

 

 

 

 

 

 

FATHER’S/GUARDIAN’S/FATHER’S DOMESTIC PARTNER’S NAME

LAST

MIDDLE

 

FIRST

 

BUSINESS TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

HOME ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

HOME TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

MOTHER’S/GUARDIAN’S/MOTHER’S DOMESTIC PARTNER’S NAME

LAST

MIDDLE

 

FIRST

 

BUSINESS TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

HOME ADDRESS

NUMBER

STREET

 

CITY

STATE

ZIP

HOME TELEPHONE

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

PERSON RESPONSIBLE FOR CHILD

LAST NAME

 

MIDDLE

FIRST

HOME TELEPHONE

BUSINESS TELEPHONE

 

 

 

 

 

 

(

)

(

)

 

 

 

 

 

 

 

 

 

 

ADDITIONAL PERSONS WHO MAY BE CALLED IN AN EMERGENCY

NAME

ADDRESS

TELEPHONE

RELATIONSHIP

PHYSICIAN OR DENTIST TO BE CALLED IN AN EMERGENCY

PHYSICIAN

 

ADDRESS

MEDICAL PLAN AND NUMBER

TELEPHONE

 

 

 

 

(

)

 

 

 

 

 

DENTIST

 

ADDRESS

MEDICAL PLAN AND NUMBER

TELEPHONE

 

 

 

 

(

)

 

 

 

 

IF PHYSICIAN CANNOT BE REACHED, WHAT ACTION SHOULD BE TAKEN?

 

 

 

CALL EMERGENCY HOSPITAL

OTHER

EXPLAIN: ____________________________________________________________________________________________________________________

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 CALLED FOR

SIGNATURE OF PARENT/GUARDIAN OR AUTHORIZED REPRESENTATIVE

DATE

TO BE COMPLETED BY FACILITY DIRECTOR/ADMINISTRATOR/FAMILY CHILD CARE HOMES LICENSEE

DATE OF ADMISSION

LIC 700 (8/08)(CONFIDENTIAL)

DATE LEFT

Form Characteristics

Fact Name Fact Description
Purpose The LIC 700 form is used to collect identification and emergency information for children in child care centers and family child care homes.
Completion The form must be completed by a parent or authorized representative of the child.
Emergency Contacts It requires the names and contact information for emergency contacts, including physicians and dentists.
Legal Framework This form is governed by the California Health and Safety Code, specifically related to child care licensing requirements.
Confidentiality The form is marked as confidential, ensuring that the information contained is protected and used solely for emergency purposes.

Guidelines on Utilizing Lic 700

When preparing to complete the Lic 700 form, it's essential to have all the necessary information handy. This includes details about the child, parents or guardians, and emergency contacts. The process is straightforward, and following these steps will ensure that you fill out the form correctly.

  1. Start by entering the child’s name in the designated fields, ensuring to fill in their last, middle, and first names.
  2. Provide the child’s sex and birthdate to help identify them clearly.
  3. Include a telephone number where you can be reached and the child’s residential address, filling in the number, street, city, state, and ZIP code.
  4. Next, fill out the father’s or guardian's name, including last, middle, and first. Be sure to include their business and home telephone numbers, as well as their home address.
  5. Similarly, provide the mother’s or guardian's name along with their contact details and home address in the same manner.
  6. Identify the person responsible for the child by providing their full name and contact information for both home and business telephone numbers.
  7. Add details of additional persons who may be contacted in an emergency by providing their names, addresses, telephone numbers, and relationships to the child.
  8. Specify the physician and dentist to be called in an emergency, detailing their addresses, medical plans with numbers, and contact telephone numbers.
  9. Indicate the action to be taken if the physician cannot be reached by checking the appropriate box, either for an emergency hospital or other, with an explanation if necessary.
  10. List any persons authorized to take the child from the facility, providing their names, relationships to the child, and the time the child will be called for.
  11. Finally, ensure that the form is signed and dated by the parent, guardian, or authorized representative at the bottom of the document.

What You Should Know About This Form

What is the Lic 700 form?

The Lic 700 form, also known as the Identification and Emergency Information form, is a document required by the California Department of Social Services. It is specifically designed for child care centers and family child care homes. This form gathers essential information about the child, including contact details for parents or guardians, emergency contacts, and medical information. Its primary purpose is to ensure the safety and well-being of children in care settings.

Who is responsible for completing the Lic 700 form?

The Lic 700 form must be completed by a parent or an authorized representative. This responsibility ensures that the information is accurate and reflects the current circumstances of the child. Parents should provide as much detail as possible, as this information will be crucial in emergencies or when someone else needs to pick up the child.

What information does the Lic 700 form require?

This form requests a variety of information. Key details include the child's name, birthdate, and address. It also collects information about the child's parents or guardians, including names and contact numbers. Additionally, the form asks for emergency contacts, a physician or dentist to reach out to if necessary, and any special instructions regarding the child's care. It’s vital to complete all sections to ensure proper communication and care.

What should I do if my child’s information changes?

If there are any changes in your child's information—such as a new phone number, a change in guardianship, or updated emergency contacts—you must update the Lic 700 form as soon as possible. Keeping this information current is essential to ensure that child care providers can reach you in case of an emergency.

How is the information on the Lic 700 form protected?

The Lic 700 form is considered confidential. Child care facilities are required to handle this information with care, limiting access to authorized personnel only. This confidentiality helps protect sensitive personal information from unauthorized disclosures.

What if there are individuals authorized to pick up my child?

The Lic 700 form allows parents to specify individuals authorized to take the child from the facility. It's important to list these people clearly, as the facility will not release the child to anyone not listed on the form without explicit, written permission from the parent or an authorized representative. This procedure adds an extra layer of security for the child's safety.

Is the Lic 700 form required for all child care facilities?

Common mistakes

Filling out the Lic 700 form can be straightforward, but many make common mistakes that can delay processing or create complications. One frequent error is failing to provide complete and accurate contact information. Parents often omit phone numbers or use incorrect addresses, which can hinder effective communication in emergencies. Ensuring that every part of this information is filled out is crucial.

Another mistake involves not updating information when circumstances change. As life evolves, so do contact details and emergency contacts. Parents might neglect to revise this information following a move or a change in guardianship. Keeping the Lic 700 form current is essential for the safety and well-being of the child.

Some individuals overlook including all necessary emergency contacts. This form allows for multiple contacts, and it's beneficial to utilize this section fully. By not listing all reliable individuals who can be reached in emergencies, parents limit their options in critical situations.

Additionally, parents often misinterpret the section regarding authorization for pick-up. All individuals authorized to take the child from the facility must be named. Failing to include someone's name could lead to confusion or frustration, particularly if a child needs to be picked up unexpectedly.

Not explaining further actions if the physician cannot be reached is another common oversight. The form provides a section for parents to specify instructions in such cases. Leaving this blank can create uncertainty for caregivers about how to proceed if urgent medical attention is needed.

Lastly, many forget to sign and date the form. This signature indicates acknowledgment and consent, which is essential for the form’s validity. Without this crucial step, the form might be deemed incomplete, delaying its acceptance and essential processes.

Documents used along the form

The Lic 700 form serves as an essential document for child care centers and family child care homes in California. To ensure a comprehensive understanding of the child's emergency information and identification, several additional forms and documents are typically utilized. The following list outlines some of the most common supplementary forms.

  • Lic 701 - Personnel Record: This document contains essential information regarding the staff members' backgrounds, qualifications, and training. It helps ensure that all caregivers are properly vetted and equipped to provide child care services.
  • Lic 702 - Child Care Center Application: This application is necessary for organizations seeking to establish a licensed child care center. It provides detailed information regarding the facility's operation, capacity, and services.
  • Lic 703 - Child's Admission Agreement: This agreement outlines the terms and conditions under which the child will be cared for. It includes important details about fees, hours of operation, and parental responsibilities.
  • Lic 704 - Staff Immunization Records: This record details the immunizations received by the facility's staff. Keeping this information current is crucial to maintaining a safe environment for children.
  • Lic 705 - Child Health Certificate: A health certificate must be completed by a licensed physician and serves as proof of the child's health status prior to admission. It often includes vaccination history as well.
  • Lic 706 - Emergency Evacuation Plan: This plan outlines the procedures that will be followed in the event of an emergency. It emphasizes the safety and preparedness protocols implemented to protect children and staff.
  • Lic 707 - Child’s Medical History: Documenting a child's medical history is essential for providing appropriate care. This form includes information on allergies, medications, and any pre-existing conditions.
  • Lic 708 - Caregiver Minimum Qualifications: This form details the minimum qualifications and training required for caregivers. It ensures that all personnel meet necessary state mandates to provide safe and effective child care.
  • Lic 709 - Incident Report Form: This document is used to record any incidents or accidents that occur within the child care facility. It assists in maintaining transparency and accountability.

Collectively, these documents provide a framework for ensuring that children are cared for in a safe, secure, and well-regulated environment. Each form plays a critical role in maintaining compliance with state regulations and addressing the well-being of children under care.

Similar forms

  • Emergency Contact Form: Like the Lic 700 form, this document collects critical details about emergency contacts for a child. Both forms require information on who can be contacted in case of an incident, ensuring that caregivers have immediate access to key individuals.

  • Child Information Form: This document shares similarities in gathering essential data about the child, such as name, birthdate, and contact information. Both forms serve to provide caregivers with vital information for effective care and communication.

  • Medical Authorization Form: The Lic 700 form and this type of document both authorize caregivers to seek medical attention in emergencies. Each requires information about medical professionals who can be contacted, ensuring that the child’s health needs are addressed promptly.

  • Consent for Release of Information Form: This document, like the Lic 700, may require signatures from parents or guardians, permitting the release of their child’s information to designated individuals. It ensures that the caregivers can legally share necessary information while respecting privacy.

  • Pickup Authorization Form: Both the Lic 700 form and this form inform caregivers who is permitted to pick up a child from a facility. They enhance security by requiring signatures and details about authorized individuals.

  • Child Care Enrollment Form: Similar to the Lic 700, this document gathers comprehensive enrollment data about a child. Both emphasize the importance of detailed information to facilitate smooth operational procedures and ensure safety.

Dos and Don'ts

When filling out the Lic 700 form, it's essential to ensure accuracy and completeness. Here are some key points to consider.

  • Do: Provide accurate and current information for your child’s name, address, and birthdate. This helps in identifying the child correctly.
  • Do: Include contact information for both parents or guardians. This ensures that emergency contacts are readily available.
  • Do: List any additional persons who may be contacted in an emergency. This adds an extra layer of safety for your child.
  • Do: Sign and date the form. Your signature is a confirmation of the accuracy of the information provided.
  • Don't: Leave any fields blank. If the information is not applicable, indicate that rather than omitting it.
  • Don't: Use abbreviations or nicknames in the name fields. Full legal names are required.
  • Don't: Forget to update the form if there are any changes in your contact information or authorized persons.
  • Don't: Assume that emergency contacts will be verified later. Ensure all contact numbers are correct and accessible.

Misconceptions

Misconceptions about the Lic 700 form can lead to confusion for parents and caregivers. It’s important to clarify these misunderstandings to ensure proper usage and compliance. Here are four common misconceptions:

  • Misconception 1: The Lic 700 form is optional for all childcare facilities.
  • Many believe that filling out the Lic 700 form is not mandatory for all childcare centers or family childcare homes. However, this is not true. The form is essential for ensuring that the facility has accurate emergency contact information and identification details for each child in case of an emergency. Without it, caregivers may lack vital information needed to assist children properly.

  • Misconception 2: The information on the Lic 700 form is not confidential.
  • Some might think that the information provided on the Lic 700 is public knowledge. This misconception can deter parents from completing the form. In reality, the form is labeled as confidential. Licensing agencies take privacy seriously, and the details provided are protected to ensure the safety and security of the child.

  • Misconception 3: Once submitted, the Lic 700 form does not require updates.
  • There is a common belief that the Lic 700 form remains static after it is submitted. However, life changes—such as new emergency contacts, changes in health providers, or alterations in living arrangements—require updates to the form. Keeping the information current is crucial for effective emergency response.

  • Misconception 4: The Lic 700 form is only for emergency situations with no other purpose.
  • Lastly, some may think the Lic 700 form serves solely emergency purposes. While it does play a critical role in emergencies, the information gathered also aids in the daily care of children. It helps childcare providers understand parental preferences and requirements, ensuring a safer, more informed environment for every child.

Key takeaways

  • The LIC 700 form is an essential document designed for Child Care Centers and Family Child Care Homes in California.
  • It must be accurately completed by the parent or authorized representative to provide critical information about the child.
  • The form requires details such as the child's name, birthdate, and address, so ensure this information is current and correct.
  • Parents should include contact numbers for themselves as well as for emergency contacts. This ensures swift communication if needed.
  • Provide information about the child's physician and dentist, including their addresses and phone numbers. This allows caregivers to reach medical professionals in an emergency.
  • If the physician is unavailable, parents must specify what actions should be taken in an emergency situation, like calling an emergency hospital.
  • Include names and relationships of individuals authorized to pick up the child from the facility. This prevents unauthorized access.
  • The completed form must be signed by a parent, guardian, or authorized representative. This verification is vital for the document's validity.
  • Keep a copy of the completed LIC 700 form on hand. Having a backup can be beneficial in case of any discrepancies.
  • Facilities may keep this form confidential; however, they should have access to it at all times for emergencies.