Form LIC 613A, Personal Rights - Child Care Centers, is a document signed by a child's parent, guardian, or representative in order to acknowledge that a child's personal rights are observed and respected while the child is receiving services from a child care center. Once the form is signed, the bottom of the document is detached and placed in the child's file, while the representative keeps the upper part of the form.
This form was released by the California Department of Social Services (CDSS), a component of the California Health and Human Services Agency (CHHS), in August 2008. Download a fillable LIC 613A Form through the link below.
Form LIC 613A (SP), Derechos Personales - Guarderías Infantiles, a LIC 613A Spanish version, can also be found on our website.
The LIC personal rights form specifies the following rights of the child: