Form LIC995 "Child Care Center Notification of Parent's Rights" - California

What Is Form LIC995?

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

Form Details:

  • Released on September 1, 2008;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form LIC995 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form LIC995 "Child Care Center Notification of Parent's Rights" - California

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STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHILD CARE CENTER
NOTIFICATION OF PARENTS’ RIGHTS
PARENTS’ RIGHTS
As a Parent/Authorized Representative, you have the right to:
1.
Enter and inspect the child care center without advance notice whenever children are in care.
2.
File a complaint against the licensee with the licensing office and review the licensee’s public file
kept by the licensing office.
3.
Review, at the child care center, reports of licensing visits and substantiated complaints against the
licensee made during the last three years.
4.
Complain to the licensing office and inspect the child care center without discrimination or retaliation
against you or your child.
5.
Request in writing that a parent not be allowed to visit your child or take your child from the child
care center, provided you have shown a certified copy of a court order.
6.
Receive from the licensee the name, address and telephone number of the local licensing office.
Licensing Office Name:
_________________________________________________
Licensing Office Address:
_________________________________________________
Licensing Office Telephone #:
_________________________________________________
7.
Be informed by the licensee, upon request, of the name and type of association to the child care
center for any adult who has been granted a criminal record exemption, and that the name of the
person may also be obtained by contacting the local licensing office.
8.
Receive, from the licensee, the Caregiver Background Check Process form
.
NOTE: C
ALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A
PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE
POSES A RISK TO CHILDREN IN CARE.
For the Department of Justice “Registered Sex Offender”database, go to www.meganslaw.ca.gov
(Detach Here - Give Upper Portion to Parents)
LIC 995 (9/08)
A C K N O W L E D G E M E N T O F N O T I F I C AT I O N O F PA R E N T S ’ R I G H T S
(Parent/Authorized Representative Signature Required)
I, the parent/authorized representative of ________________________________________________, have
received a copy of the “CHILD CARE CENTER NOTIFICATION OF PARENTS’ RIGHTS” and the
CAREGIVER BACKGROUND CHECK PROCESS form from the licensee.
_____________________________________
Name of Child Care Center
______________________________________________
__________________
Signature (Parent/Authorized Representative)
Date
This Acknowledgement must be kept in child’s file and a copy of the Notification given to
NOTE:
parent/authorized representative.
For the Department of Justice “Registered Sex Offender”database go to www.meganslaw.ca.gov
LIC 995 (9/08)
STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHILD CARE CENTER
NOTIFICATION OF PARENTS’ RIGHTS
PARENTS’ RIGHTS
As a Parent/Authorized Representative, you have the right to:
1.
Enter and inspect the child care center without advance notice whenever children are in care.
2.
File a complaint against the licensee with the licensing office and review the licensee’s public file
kept by the licensing office.
3.
Review, at the child care center, reports of licensing visits and substantiated complaints against the
licensee made during the last three years.
4.
Complain to the licensing office and inspect the child care center without discrimination or retaliation
against you or your child.
5.
Request in writing that a parent not be allowed to visit your child or take your child from the child
care center, provided you have shown a certified copy of a court order.
6.
Receive from the licensee the name, address and telephone number of the local licensing office.
Licensing Office Name:
_________________________________________________
Licensing Office Address:
_________________________________________________
Licensing Office Telephone #:
_________________________________________________
7.
Be informed by the licensee, upon request, of the name and type of association to the child care
center for any adult who has been granted a criminal record exemption, and that the name of the
person may also be obtained by contacting the local licensing office.
8.
Receive, from the licensee, the Caregiver Background Check Process form
.
NOTE: C
ALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A
PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE
POSES A RISK TO CHILDREN IN CARE.
For the Department of Justice “Registered Sex Offender”database, go to www.meganslaw.ca.gov
(Detach Here - Give Upper Portion to Parents)
LIC 995 (9/08)
A C K N O W L E D G E M E N T O F N O T I F I C AT I O N O F PA R E N T S ’ R I G H T S
(Parent/Authorized Representative Signature Required)
I, the parent/authorized representative of ________________________________________________, have
received a copy of the “CHILD CARE CENTER NOTIFICATION OF PARENTS’ RIGHTS” and the
CAREGIVER BACKGROUND CHECK PROCESS form from the licensee.
_____________________________________
Name of Child Care Center
______________________________________________
__________________
Signature (Parent/Authorized Representative)
Date
This Acknowledgement must be kept in child’s file and a copy of the Notification given to
NOTE:
parent/authorized representative.
For the Department of Justice “Registered Sex Offender”database go to www.meganslaw.ca.gov
LIC 995 (9/08)