PDF
Word
Form LIC995a Family Child Care Home Notification of Parents' Rights - California
What Is LIC 995A Form?
Form LIC 995A, Family Child Care Home Notification Of Parents' Rights , is a childcare-related form issued and distributed by the Community Care Licensing Division , a component of the California Department of Social Services (CDSS) . The latest edition of the form was released by the CDSS on August 1, 2008 .
An up-to-date fillable LIC 995A form is available for download and digital filing below. Other CDSS forms can be found through the link to our CDSS forms and brochures database. The file below requires a desktop Acrobat Reader or a browser extension to view and file. An LIC 995A Spanish version is also available by clicking this download link.
Family Child Care Home Notification of Parents Rights
The California Code of Regulations Title 22 on admission procedures and parental and authorized representative's rights describes the rights of parents or authorized representatives of children in family child care homes as the following:
- The parents or representatives have the rights to visit and inspect the family child care home.
- They have the right to file complaints against the child care facility licensee with the local licensing office and to complain to the local licensing office and inspect the family child care home without discrimination or retaliation.
- They may review the family child care home's public files, reports of licensing visits, and previous complaints against the licensee made during the last three years.
- The parents or representatives are allowed to request in writing that a parent not be allowed to visit a child or take a child from the family child care home, provided the custodial parent has shown a certified copy of a court order pursuant to the Health and Safety Code Section 1596.857.
The licensee is obligated to put up Form PUB 394, Notification of Parents' Rights - California, in a visible and accessible area of the family child care home and provide the parents or representatives with a filled-out Form LIC 995E, Caregiver Background Check Process.
When a child is taken into care, the licensee has to provide the child's parent or authorized representative with a copy of Form LIC 995A , Form LIC 995E, and Form LIC 9212, Family Child Care Consumer Awareness Information. The licensee has to ensure that the parent or representative signs the bottom tear-away portion of the LIC 995A, which certifies that the person signing has read and is acknowledging the main statements of the LIC 995A.
This bottom portion of the form is stored in the child's personal file and can serve as proof that the parent or authorized representative has been notified of their rights and has received all of the necessary forms and paperwork from the licensee.
As soon as the parent or representative arranges for childcare services (or on the first day the child starts receiving care) the licensee has to provide that parent or representative with a copy of Form LIC 995B, Addendum to Notification of Parent's Rights (Regarding Removal/Exclusion).
Not what you were looking for? Check out these childcare-related forms:
- Form LIC 282, Affidavit Regarding Liability Insurance for Family Child Care Home;
- Form LIC 610, Emergency Disaster Plan For Child Care Facilities;
- Form LIC 610A, Emergency Disaster Plan For Family Child Care Homes;
- Form LIC 613A, Personal Rights - Child Care Facilities;
- Form LIC 624, Unusual Incident/Injury Report;
- Form LIC 624B, Unusual Incident/Injury Report - Family Child Care Homes;
- Form LIC 627, Consent For Emergency Medical Treatment - Child Care Centers Or Family Child Care Homes;
- Form LIC 700, Identification And Emergency Information Child Care Centers/Family Child Care Homes.
