Form LIC282 "Affidavit Regarding Liability Insurance for Family Child Care Home" - California

What Is LIC 282 Form?

Form LIC 282, Affidavit Regarding Liability Insurance For Family Child Care Home, is a questionnaire developed by the California Department of Social Services (CDSS). This form is supposed to be filled out by the parents or guardians of a child who is enrolling in a child care facility.

Alternate Name:

  • LIC 282 Child Care Form.

The purpose of the form is to provide family child care providers with signed confirmation from the parents or guardians of a child on the subject of liability insurance in the facility.

This form was last revised on August 1, 2008. A printable copy of the LIC 282 Child Care Form is available for download below.

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Form LIC 282 Instructions

Since the document is presented in the form of confirmation, there is a small amount of information that is required to be filled out. Regarding the specifics of it, the LIC 282 Form consists of two parts, each of which is dedicated to a different case. The filer must fill out only the part that is applicable to their situation.

  1. If the facility doesn't carry liability insurance in accordance with the established standards, then the filer is supposed to fill out the first part of the affidavit.
  2. The second part is for cases where the licensee doesn't own the premises. It is also suitable to use it for cases when the licensee is a member of a Homeowner's Association or condominium.
  3. Regardless of the differences, both parts consist of the same charts, that require the following information:
    • The child's name;
    • The licensee's name;
    • The name of the family child care home.

After completing the form, it is supposed to be submitted to the family child care providers as they must keep the signed form in the facility file. According to the form, family child care providers are required by law to carry liability insurance in the amount of $300,000 every year or to have this affidavit signed by the filer in their documents.

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Download Form LIC282 "Affidavit Regarding Liability Insurance for Family Child Care Home" - California

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
AFFIDAVIT REGARDING LIABILITY INSURANCE
FOR FAMILY CHILD CARE HOME
SECTION A:
I/We, the parent(s)/guardian(s) of_________________________________________________________,
(Child's Name)
acknowledge that _____________________________________________________________________________________,
(Licensee'sName)
the licensee of _______________________________________________________________________________________,
(Name of Family Child Care Home)
has informed me/us that this facility does not carry liability insurance or a bond in accordance with standards established by
Family Child Care statute.
SECTION B: To be completed only if licensee does not own premises or the licensee is a member of a condominium
or Homeowner's Association.
I/We, the parent(s)/guardian(s) of _________________________________________________________,
(Child's Name)
acknowledge that ______________________________________________________________________________________,
(Licensee's Name)
the licensee of________________________________________________________________________________________.
(Name of Family Child Care Home)
has informed me/us that she/he does not own the premises or is a member of a condominium or Homeowner's Association,
and the liability insurance, if any, of the owner/Homeowners' Association may not provide coverage for losses arising out of, or
in connection with, the operation of the family child care home, except to the extent that the losses are caused by, or result
from, an action or omission by the owner/Homeowners' Association, for which the owner/Homeowners' Association would
otherwise be liable under the law.
Signature of Parent(s)/Guardian(s)
Date
NOTE: The law requires Family Child Care providers to carry liability insurance or bond in the amount of $300,000 annually or
to maintain this signed statement in the facility file. Lack of a bond or insurance does not effect the right of parents to bring
legal action against the facility.
LIC 282 (8/08)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
AFFIDAVIT REGARDING LIABILITY INSURANCE
FOR FAMILY CHILD CARE HOME
SECTION A:
I/We, the parent(s)/guardian(s) of_________________________________________________________,
(Child's Name)
acknowledge that _____________________________________________________________________________________,
(Licensee'sName)
the licensee of _______________________________________________________________________________________,
(Name of Family Child Care Home)
has informed me/us that this facility does not carry liability insurance or a bond in accordance with standards established by
Family Child Care statute.
SECTION B: To be completed only if licensee does not own premises or the licensee is a member of a condominium
or Homeowner's Association.
I/We, the parent(s)/guardian(s) of _________________________________________________________,
(Child's Name)
acknowledge that ______________________________________________________________________________________,
(Licensee's Name)
the licensee of________________________________________________________________________________________.
(Name of Family Child Care Home)
has informed me/us that she/he does not own the premises or is a member of a condominium or Homeowner's Association,
and the liability insurance, if any, of the owner/Homeowners' Association may not provide coverage for losses arising out of, or
in connection with, the operation of the family child care home, except to the extent that the losses are caused by, or result
from, an action or omission by the owner/Homeowners' Association, for which the owner/Homeowners' Association would
otherwise be liable under the law.
Signature of Parent(s)/Guardian(s)
Date
NOTE: The law requires Family Child Care providers to carry liability insurance or bond in the amount of $300,000 annually or
to maintain this signed statement in the facility file. Lack of a bond or insurance does not effect the right of parents to bring
legal action against the facility.
LIC 282 (8/08)