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

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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 . 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.

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

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