Forms
Required Forms for Enrollment
As per the Title 22 California Code of Regulations, the following forms are due prior to enrollment:
- Application for Services Community or Student/Funded
- Identification and Emergency Information (LIC 700)
- Child’s Pre-Admission Health History-Parent’s Report (LIC 702)
- Physician’s Report (LIC 701)
- Consent for Medical Treatment (LIC 627)
- Immunization Record and TB Test
- Notification of Parents’ Rights (LIC 995)
- Personal Rights-Childcare Facilities (LIC 613A)
- Parent Handbook Policy Agreement
- Handbook Signature Page
- Birth Certificate
- Family Interview Form
- Meal Benefit Form or Non-Participation Form
- Model Release
As per the California Education Title 5, funded childcare, the following forms are due prior to enrollment in addition to required Title 22 forms:
- Employer Verification Form
- Self Employed Verification
- Education Plan
- Address Verification (Lease, Rental or Mortgage agreement)
- Birth Certificate of all children under 18 in the household
- Income Verification (Pay stubs, cash aide, financial aide, or any other income totaling 1 month)
- Current Class schedule
Optional Forms
Last Updated: 03/06/2020
