Form LIC 9040, Child Care Facility Roster, is a legal document completed by child care facilities to list all the children who are provided care in these facilities - child care centers, infant care centers, school-age centers, and family child care homes. Each facility must maintain individual records for its employees and individuals who receive care to be in compliance with licensing requirements and to be in a better position to respond adequately to emergency situations.
This form was issued by the California Department of Social Services (CDSS), a component of the California Health and Human Services Agency (CHHS). The latest version of the form was released on October 1, 2005, with all previous editions obsolete. You can download a fillable LIC 9040 Form through the link below.
To identify children and establish the necessary details of the people to be reached if children are involved in emergency situations, you are required to fill out Form LIC 700, Identification and Emergency Information (Child Care Centers/Family Child Care Homes).
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