Form 50548 "Licensed Child Care Center/Home Consent Form" - Indiana

What Is Form 50548?

This is a legal form that was released by the Indiana Department of Family & Social Services Administration - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2006;
  • The latest edition provided by the Indiana Department of Family & Social Services Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 50548 by clicking the link below or browse more documents and templates provided by the Indiana Department of Family & Social Services Administration.

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Download Form 50548 "Licensed Child Care Center/Home Consent Form" - Indiana

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LICENSED CHILD CARE CENTER / HOME CONSENT
State Form 50548 (R2 / 7-06) / BCC 0080
To:
Parents of licensed child care programs in Indiana
Subject: Your child’s birth certificate and licensed child care programs
Indiana Code 12-17.2-2-1(8) requires each child care center or child care home to record proof of a child’s date of birth before accepting
the child for care. A child’s date of birth may be proven by the child’s original birth certificate or other reliable proof of the child’s date of
birth, including a duly attested transcript of a birth certificate. Refusing to share this information may result in your child’s exclusion from
a licensed child care program. Sharing the birth certificate information is NOT optional; signing the below is your decision and does not
impact your use of child care facilities.
tear here
LICENSED CHILD CARE CENTER / HOME CONSENT
State Form 50548 (R2 / 4-06) / BCC 0080
This portion is to be kept on file at the licensed child care program.
I give my permission for ____________________________________________________________ to report the name and date of birth
name of licensed child care program
of my child or children to the Division of Family Resources pursuant to IC 12-17.2-2-1.5.
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Signature of parent, guardian, or custodian
Date signed (month, day, year)
LICENSED CHILD CARE CENTER / HOME CONSENT
State Form 50548 (R2 / 7-06) / BCC 0080
To:
Parents of licensed child care programs in Indiana
Subject: Your child’s birth certificate and licensed child care programs
Indiana Code 12-17.2-2-1(8) requires each child care center or child care home to record proof of a child’s date of birth before accepting
the child for care. A child’s date of birth may be proven by the child’s original birth certificate or other reliable proof of the child’s date of
birth, including a duly attested transcript of a birth certificate. Refusing to share this information may result in your child’s exclusion from
a licensed child care program. Sharing the birth certificate information is NOT optional; signing the below is your decision and does not
impact your use of child care facilities.
tear here
LICENSED CHILD CARE CENTER / HOME CONSENT
State Form 50548 (R2 / 4-06) / BCC 0080
This portion is to be kept on file at the licensed child care program.
I give my permission for ____________________________________________________________ to report the name and date of birth
name of licensed child care program
of my child or children to the Division of Family Resources pursuant to IC 12-17.2-2-1.5.
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Name of child
Date of birth (month, day, year)
Signature of parent, guardian, or custodian
Date signed (month, day, year)