Form OCC673 "Request for Continuing Family Child Care Home Registration" - Maryland

What Is Form OCC673?

This is a legal form that was released by the Maryland State Department of Education - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the Maryland State Department of Education;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form OCC673 by clicking the link below or browse more documents and templates provided by the Maryland State Department of Education.

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Download Form OCC673 "Request for Continuing Family Child Care Home Registration" - Maryland

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MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care
REQUEST FOR CONTINUING FAMILY CHILD CARE HOME REGISTRATION
FACILITY:
___________________
REGISTRATION #:_________________
The above named facility's family child care registration is due to expire on ___________________ ____
Please check your preference below and mail back to:
Licensing Specialist _______________________________________ Phone __________________________
Address: _________________________________________________________________________________
Email: ___________________________________________________________________________________
I will not continue to provide child care beyond the expiration date of my family child care
registration. I will voluntarily close my family child care home by the above noted expiration date.
Signature ____________________________________________________ Date _______________________
I desire to continue to provide child care beyond the expiration date of my family child care
registration and hereby submit the required documentation for conversion of my current registration to
continuing (non-expiring) status. I agree to abide by the requirements of COMAR 13A.15.01-.15. I
understand that reporting false information may be grounds for denial or revocation of my family child
care registration.
Signature ____________________________________________________ Date _______________________
List all household members on page 2 of this form, and complete the section related to Homeowners’
Liability Insurance Coverage, if applicable.
OCC 673 - Revised 3/15 - All previous editions are obsolete.
Page 1 of 2
MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care
REQUEST FOR CONTINUING FAMILY CHILD CARE HOME REGISTRATION
FACILITY:
___________________
REGISTRATION #:_________________
The above named facility's family child care registration is due to expire on ___________________ ____
Please check your preference below and mail back to:
Licensing Specialist _______________________________________ Phone __________________________
Address: _________________________________________________________________________________
Email: ___________________________________________________________________________________
I will not continue to provide child care beyond the expiration date of my family child care
registration. I will voluntarily close my family child care home by the above noted expiration date.
Signature ____________________________________________________ Date _______________________
I desire to continue to provide child care beyond the expiration date of my family child care
registration and hereby submit the required documentation for conversion of my current registration to
continuing (non-expiring) status. I agree to abide by the requirements of COMAR 13A.15.01-.15. I
understand that reporting false information may be grounds for denial or revocation of my family child
care registration.
Signature ____________________________________________________ Date _______________________
List all household members on page 2 of this form, and complete the section related to Homeowners’
Liability Insurance Coverage, if applicable.
OCC 673 - Revised 3/15 - All previous editions are obsolete.
Page 1 of 2
HOMEOWNERS’ LIABILITY INSURANCE COVERAGE
Complete this section only if your family day care home is located in a condominium or other residence that
requires homeowners’ association membership (NOTE: the Homeowners' Liability Insurance policy must be
applicable to child care):
Name of Insurance Company: ________________________________________________________________
Insurance Policy/Binder Number: _____________________________________________________________
Effective Date of Coverage: ________________________
Expiration Date: _________________________
CURRENT HOUSEHOLD RESIDENTS
List all children and adults living in the home:
FULL NAME
BIRTHDATE
RELATIONSHIP
RACE
MARITAL
SOCIAL SECURITY #
STATUS
OCC 673 - Revised 3/15 - All previous editions are obsolete.
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