title: lic 995e.pdf author: ca dept of social services created date: 0000005152 00000 n Emergency Disaster Plan (LIC 610, LIC 610A and 610A (SP)) and be made accessible to the public. 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U4248002 Paula 6-1-00 Back INSTRUCTIONS FOR SCHOOL OR CHILD CARE STAFF 1. LIC 9221 (8/08) TIME GIVEN TIME GIVEN TIME GIVEN TIME GIVEN TIME GIVEN STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE DATE: ENDING DATE TIME OF DAY PARENT’S INSTRUCTIONS: 1. is a title of courtesy used in Spanish for someone with a bachelor's degree. Todas las medicinas recetadas o sin receta se deben mantener con el nombre del niño y deben tener fecha. 0000019094 00000 n 0000004663 00000 n 0000004349 00000 n Give parents top part and keep bottom part in record. License # SP98365808. 0000004517 00000 n 5. The Division of Professional Licensure (DPL) oversees 39 boards, which license and regulate more than 167 trades and professions in Massachusetts. 3y_��BtF�� endstream endobj 33 0 obj << /Type /Annot /Subtype /Widget /Rect [ 357.85135 582.90897 574.38034 601.91724 ] /P 29 0 R /F 4 /T (�C�ܥ7) /FT /Tx /AA << >> /DA (�j���%ύ�A.��JZ) /DR 60 0 R /AP << /N 34 0 R >> >> endobj 34 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 216.52899 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream UTILITY SHUT OFF -Indicate locations on the Facility Sketch (LIC 999A) with the exit routes. 'uj����m���%,) /DR 60 0 R /AP << /N 38 0 R >> >> endobj 38 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 183.47113 18.18182 ] /Resources << /ProcSet [ /PDF ] >> >> stream Designed for the submission of form LIC 701, this child care program app tracks important details, including parental consent, immunization history, and the licensed physician's report. 0000002535 00000 n 0000001224 00000 n 0000002084 00000 n Health Insurance Premium Payment Application (SP) California Children's Services (CCS) The following are applications to enroll children and pregnant women in the Medi-Cal or Healthy Families program. STATE FORMS LIC 311 D In an effort to assist our members we have provided a list of some of these required forms. %PDF-1.4 %���� * yes no is child presently under a doctor’s care? yes no if yes, name of doctor: does child take prescribed medication(s)? /������ >$i:�O���̥�FA�炣}���,&�E�������,��%��1;I$$��ڱK��iVL[jkS. 0000004881 00000 n News Releases Year 2017 Current news releases from the California Department of Education's (CDE) Communications Division of the State Superintendent of Public Instruction. U4248002 Paula 6-1-00 Back INSTRUCTIONS FOR SCHOOL OR CHILD CARE STAFF 1. You will receive plates when you register your vehicle for the first time. 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Translate 916. State of California—Health and Human Services Agency California Department of Public Health The California Department of Public Health places strict controls on the gathering and use of personally identifiable data. lic 995 e (6/05) california department of social services important information for parents caregiver background check process california department of social services. Vehicle (or license) plates are a metal plate attached to a vehicle or trailer for official identification purposes. 0000003328 00000 n Please print and fill out the following forms and bring them the first day of class. 36 0 obj <>stream 0000009420 00000 n 0000001867 00000 n All prescription and nonprescription medications shall be maintained with the child’s name and … 0000008327 00000 n In the sense shown in 2), "Lic." Vehicle (or license) plates are a metal plate attached to a vehicle or trailer for official identification purposes. 0000009126 00000 n 0000002972 00000 n 0000011916 00000 n lic 702 (8/08) (confidential) word used for urination* is child toilet trained? 0000006336 00000 n 0000012860 00000 n Please make a habit of researching and checking the Department of Social Services (DSS) web site and ours for updates. 0000001642 00000 n 0000003686 00000 n 0000002385 00000 n There is no equivalent term in English. 0000016666 00000 n Complete child’s name and address information section, or ask parent or guardian to complete this section only. 2. %%EOF 0000003539 00000 n STATE FORMS LIC 311 D In an effort to assist our members we have provided a list of some of these required forms. 0000006164 00000 n 0000000856 00000 n Complete child’s name and address information section, or ask parent or guardian to complete this section only. LCAP Template Available in Spanish (En Espanol) Torlakson Announces that LCAP Template is now available in Spanish. There is no equivalent term in English. 6. �|o����� endstream endobj 39 0 obj << /Type /Annot /Subtype /Widget /Rect [ 465.2894 93.65262 606.61176 112.66089 ] /F 4 /P 29 0 R /AP << /N 40 0 R >> /Parent 2 0 R >> endobj 40 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 141.32236 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream LIC 9150 Parents notification additional children in care. 0000001588 00000 n Cut along dotted line. 0000010312 00000 n LIC 9166 Nebulizer Care Consent/Verification. 0000005861 00000 n Forms Access forms used by the Department of Health Care Services. of social services created date: 0000008019 00000 n Application to Determine CCS Program Eligibility (DHCS 4480) Alt: Spanish CCS Special … physician or dentist to be called in an emergency 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) This list is an aid to LIC 311D Forms/Records to Keep in Your Family Child Care Homes. 0000005027 00000 n 0000013280 00000 n 0000017124 00000 n 0000014994 00000 n Title: S�!f#�[� Author \�1 Created Date [�Pv!�J�q�@e 10 ��pU7� 0000006092 00000 n xref Features. 0000010212 00000 n 0000003991 00000 n 0000013304 00000 n 0 OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, … 0000003844 00000 n LIC 9095 - Evaluation of Teachers’ Qualifications LIC 9096 - Evaluation of Director Qualifications *LIC 9108 - Statement Reporting Suspected Child Abuse *LIC 9148 - Earthquake Preparedness Checklist LIC 9163 - Request for Livescan Service *LIC 9166 - Nebulizer Care Consent/Verification LIC 9182 - Criminal Background Clearance Transfer Request 0000001934 00000 n b{��ѐ6�9� endstream endobj 41 0 obj << /Type /Annot /Subtype /Widget /Rect [ 31.40497 69.68567 608.26465 88.69394 ] /P 29 0 R /F 4 /T (Y������) /FT /Tx /AA << >> /DA (� ��Ɓ�Bְ) /DR 60 0 R /AP << /N 42 0 R >> >> endobj 42 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 576.85968 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream … 0000004417 00000 n 0000011661 00000 n Want to check that a business or individual the DPL oversees has a valid license or permit? trailer Contact Information. `�S��L�jVy endstream endobj 45 0 obj << /Type /Annot /Subtype /Widget /Rect [ 319.66125 45.71872 605.61176 63.90054 ] /P 29 0 R /F 4 /T (�G|c�\)hѥ���W) /FT /Tx /AA << >> /DA (�gva�v-���ɥEi) /DR 60 0 R /AP << /N 46 0 R >> >> endobj 46 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 285.9505 18.18182 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000001613 00000 n ;94�8����:A$�D�6��e��Q�E��i����@l��k�@!�^›��$@� EL��6P�Y��nY�l���/_DF��6%�݋X�bZ?�QU�>�I]RO�9��. 0000006023 00000 n 0000004382 00000 n <<4A213ED84AE8BC40A916D2C481B5B9A3>]>> In the sense shown in 2), "Lic." "UFO" = "unidentified flying object"; "p." = "page"). 0000000016 00000 n 0000017048 00000 n state of california – health and human services agency california department of social services community care licensing division criminal background clearance transfer request The Division of Professional Licensure (DPL) oversees 39 boards, which license and regulate more than 167 trades and professions in Massachusetts. 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Please print and fill out the following forms and bring them the first day of class. 0000011753 00000 n The Consent for Emergency Medical Treatment California: LIC 627 mobile app allows parents and guardians to give their informed consent for treatment by a health care provider when they are away from home. www.thesperagroup.us. yes no if yes, what kind and any side effects: if yes, at what stage: are bowel movements regular? 0000002825 00000 n "description":"I give my consent for the above-named LICENSEE OR STAFF PERSON, who work(s) at the above-named CHILD CARE FACILITY, to administer inhaled medication to my child and to contact my child’s health care provider. An abbreviation is the shortened form of a word or group of words (e.g. 9 0 obj <> endobj 0000001382 00000 n OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, radio and other emergency equipment. 0000002234 00000 n 0000011860 00000 n Excelsior license plates are now availableGet plates for the first timeRegister your vehicle and get plates Transfer platesYou cannot transfer your plates to another person. EQUIPMENT LOCATION - The fire department may help you with installation information. 0000008857 00000 n 0000002026 00000 n 0000002685 00000 n Health Insurance Premium Payment Application (SP) California Children's Services (CCS) The following are applications to enroll children and pregnant women in the Medi-Cal or Healthy Families program. 7. Submission Editing. ����t��2���z��#? %PDF-1.6 %���� 0000002614 00000 n 0000003181 00000 n "UFO" = "unidentified flying object"; "p." = "page"). LIC 700 (SP) (8/08) (CONFIDENTIAL) A completarse por el padre/madre o el representante autorizado. Lic. EQUIPMENT LOCATION - The fire department may help you with installation information. w뵧$��}IOy���G:K��ک"i�/������T���﷖28�0u,��_�`ш�뵅��f�Ѷ�+i�5�}���͊Y����{�Ɔ�ĉD��7�}� �'�2H)��30� 7/Ւ�CY����eoi���#��հF��Mq endstream endobj 66 0 obj 155 endobj 29 0 obj << /Type /Page /Parent 11 0 R /Resources 47 0 R /Contents 50 0 R /Thumb 4 0 R /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 /Annots 30 0 R >> endobj 30 0 obj [ 31 0 R 33 0 R 35 0 R 37 0 R 39 0 R 41 0 R 43 0 R 45 0 R ] endobj 31 0 obj << /Type /Annot /Subtype /Widget /Rect [ 38.01654 582.90897 265.28934 601.91724 ] /F 4 /P 29 0 R /AP << /N 32 0 R >> /Parent 1 0 R >> endobj 32 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 227.2728 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream lic 701 (8/01) (confidential) 1st 2nd 3rd 4th 5th vaccine polio (opv or ipv) dtp/dtap/ dt/td mmr hib meningitis hepatitis b varicella (diphtheria, tetanus and [acellular] pertussis or tetanus and diphtheria only) (measles, mumps, and rubella) (required for child care only) (chickenpox) 0000010264 00000 n Consent/Verification for Nebulizer Care (LIC 9166 - English I Spanish) Identification and Emergency Information (LIC 700 - English I Spanish) Notification of Parents' Rights (LIC 995A - English I Spanish) Caregiver Background Check Process (LIC 995E - English I Spanish) Family Child Care Consumer Awareness Information (LIC … Social Services ( DSS ) web site and ours for updates con el nombre del niño deben... 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