Yes! You can use AI to fill out California Department of Social Services (CDSS) Community Care Licensing Child Care Forms Packet (LIC 9150, LIC 282, LIC 627, LIC 700, LIC 995A, CDPH 286, LIC 9227)
This content is a packet of official California Health and Human Services/Community Care Licensing and California Department of Public Health forms used to meet statutory and regulatory documentation requirements for child care and school entry. It includes parent notices (e.g., additional children in care and parents’ rights), required acknowledgements and affidavits (e.g., liability insurance disclosure), emergency medical treatment consent and emergency contact/identification information, an immunization record for pre-K through grade 12, and an individual infant sleeping plan. These forms are important because they create a compliance record for licensing, support child safety and emergency response, and document parent/guardian consent and disclosures that facilities must keep in the child’s file.
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Form specifications
| Form name: | California Department of Social Services (CDSS) Community Care Licensing Child Care Forms Packet (LIC 9150, LIC 282, LIC 627, LIC 700, LIC 995A, CDPH 286, LIC 9227) |
| Number of pages: | 9 |
| Language: | English |
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How to Fill Out CA Child Care Licensing Forms (LIC/CDPH) Online for Free in 2026
Are you looking to fill out a CA CHILD CARE LICENSING FORMS (LIC/CDPH) form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your CA CHILD CARE LICENSING FORMS (LIC/CDPH) form in just 37 seconds or less.
Follow these steps to fill out your CA CHILD CARE LICENSING FORMS (LIC/CDPH) form online using Instafill.ai:
- 1 Select the specific form(s) you need from the packet (e.g., LIC 9150, LIC 282, LIC 627, LIC 700, LIC 995A, CDPH 286, LIC 9227) based on the child’s enrollment and the facility’s licensing situation.
- 2 Enter facility and child identifiers where applicable (facility name/address; child’s full name; admission date; parent/authorized representative names and contact details).
- 3 Complete the disclosure/notification sections by checking the correct options (e.g., small vs. large family child care home capacity notice on LIC 9150; insurance/bond disclosure statements on LIC 282; parents’ rights acknowledgement on LIC 995A).
- 4 Provide emergency and medical information (LIC 627 and LIC 700): emergency consent, home/work phones, physician/dentist, medication allergies, and authorized pick-up persons and emergency contacts.
- 5 Record health compliance data if required (CDPH 286): enter vaccine dose dates, mark any permanent/temporary medical exemptions, and complete the status-of-requirements section with staff initials and follow-up dates if conditional.
- 6 If the child is an infant, complete the safe-sleep documentation (LIC 9227): home sleep environment, typical sleep schedule, pacifier use, rolling ability dates/observations, and attach any physician medical exemption documentation if applicable.
- 7 Collect required signatures and dates (parent/authorized representative, provider/licensee, and staff where required), then distribute copies as instructed (give parent copies; retain facility copies in the child’s record/file).
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Frequently Asked Questions About Form CA Child Care Licensing Forms (LIC/CDPH)
This form notifies parents that a licensed family child care home may legally care for additional children above the standard limit under specific conditions. The parent signs a receipt acknowledging they received the notice.
The child’s parent or authorized representative must receive the top portion and sign the receipt portion. The provider keeps the signed receipt in the child’s file.
The provider checks one box indicating whether they are licensed as a Small or Large Family Child Care Home. That selection determines the maximum number of children they may care for under the “additional children” rules.
A Small Family Child Care Home may care for more than six and up to eight children when one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, another child is at least six years old, and no more than two infants are in care.
A Large Family Child Care Home may care for more than 12 and up to 14 children when an assistant provider is present, one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, another child is at least six years old, and no more than three infants are in care.
The parent/authorized representative signs to acknowledge they received the notification about possible additional children in care. The completed and signed bottom half must be kept in the child’s record (facility copy).
This form documents that the provider informed the parent/guardian that the family child care home does not carry liability insurance or a bond meeting the required standard. The signed affidavit is kept in the facility file as proof of disclosure.
California law requires family child care providers to carry liability insurance or a bond of $300,000 annually, or to maintain a signed LIC 282 statement in the facility file. Even if there is no insurance or bond, parents still have the right to bring legal action.
Section B is completed only if the licensee does not own the premises or is a member of a condominium or Homeowner’s Association. It explains that the property owner/HOA insurance, if any, may not cover losses related to operating the child care home.
LIC 627 authorizes the facility to obtain emergency medical or dental care for the child if needed. The parent or authorized representative signs and provides key details such as allergies, address/phone numbers, physician/dentist, and authorized pick-up persons.
Parents/authorized representatives provide the child’s identifying information, parent/guardian details, the person responsible for the child, physician/dentist and medical plan information, emergency contacts, and instructions for what to do if the physician cannot be reached. The parent/authorized representative signs and dates the form.
LIC 995A explains rights such as inspecting the home during care hours, reviewing licensing reports, filing complaints without retaliation, and receiving licensing office contact information. The parent/authorized representative signs the acknowledgement confirming they received the Parents’ Rights notice and related consumer/background check information.
CDPH 286 is used by staff to record a child’s vaccine doses and determine whether the child meets immunization requirements for pre-kindergarten/child care, TK/K–12 admission, and 7th grade advancement/admission. It also documents exemptions and any needed follow-up dates.
Conditional admission means the child is missing required doses but is not currently due for them at the time of admission. Staff must record follow-up date(s) and review the record at least every 30 days until requirements are met.
LIC 9227 documents an infant’s typical sleep environment, sleep schedule, pacifier use, and rolling ability, and is kept confidential in the infant’s file. It is used to support safe sleep practices and to document any medical exemption for an alternate sleep position.
Compliance CA Child Care Licensing Forms (LIC/CDPH)
Validation Checks by Instafill.ai
1
Parent Notification (LIC 9150) — Exactly one license type checkbox selected
Validate that exactly one of the two options is checked: Small Family Child Care Home or Large Family Child Care Home. This is required to clearly indicate which capacity rule applies and what the parent is being notified about. If neither or both are selected, the notification is ambiguous and should be rejected for correction before filing or distributing.
2
LIC 9150 — Facility address present and complete
Ensure the “PRINT FACILITY ADDRESS” field is completed with at least street address, city, state, and ZIP (and not left blank). The facility address is essential to identify which licensed location the notification applies to and to support audits/complaints. If incomplete, the form should fail validation and be returned to the provider to complete the address.
3
LIC 9150 Receipt — Parent/authorized representative name, signature, date, and child name required
Validate that the receipt section includes the parent/authorized representative printed name (if captured), a signature, a date, and the child’s name. This receipt is the evidence that the parent received the required notification for that specific child. If any of these are missing, the receipt is not legally reliable and should be flagged as incomplete.
4
All signature/date fields — Signature present and date is valid and not in the future
For every form that includes a signature line (e.g., LIC 282, LIC 627, LIC 700, LIC 995A acknowledgement, LIC 9227), verify a signature is present and the associated date is a valid calendar date. Dates should not be in the future relative to submission/processing time, because that indicates an entry error or pre-dating. If invalid, the record should be rejected or routed for correction depending on policy.
5
Affidavit re Liability Insurance (LIC 282) — Section A child name, licensee name, and home name required
Validate that Section A includes the child’s name, the licensee’s name, and the family child care home name. These fields identify the parties and the specific facility for which the no-insurance acknowledgement applies. If any are missing, the affidavit cannot be tied to the correct child/facility and should fail validation.
6
LIC 282 — Section B completion conditional on premises/HOA status
If the submission indicates the licensee does not own the premises or is part of a condominium/HOA (or if Section B is present/selected), require Section B’s child name, licensee name, home name, parent/guardian signature, and date. If the licensee owns the premises and is not in an HOA, Section B should be blank or explicitly marked not applicable to avoid conflicting statements. If Section B is partially completed or contradicts the stated status, flag for review.
7
Emergency Medical Consent (LIC 627) — Facility name and child name required
Ensure the facility name and the child’s name are completed on the consent statement. This consent authorizes emergency care for a specific child at a specific facility, and missing identifiers can invalidate the authorization. If either field is blank, the form should be considered incomplete and not accepted.
8
LIC 627 — Home address and phone number format validation
Validate that the home address is present and structured (street, city, state, ZIP) and that home phone (and work phone if provided) matches an acceptable phone format (e.g., 10 digits with optional punctuation). Accurate contact information is critical during emergencies and for compliance. If phone numbers are malformed or address is missing, the submission should be flagged for correction.
9
LIC 627 — Medication allergies field must be explicitly completed (value or 'None')
Require that the medication allergies field is not left blank; it must contain allergy details or an explicit indication such as “None/No known allergies.” This prevents ambiguity that could lead to unsafe medication administration in an emergency. If blank, fail validation and request clarification.
10
Identification & Emergency Information (LIC 700) — Child identity fields complete and consistent
Validate that the child’s full name (first/middle/last as applicable), address, birthdate, and sex/gender fields are completed, and that the birthdate is a valid date. These fields are used to identify the child and coordinate emergency care and records. If missing or invalid, the record should be rejected or held until corrected.
11
LIC 700 — Parent/guardian and responsible party information completeness
Ensure at least one parent/guardian (mother/guardian or father/guardian) is provided with name and contact address, and that the “person responsible for child” is completed. This ensures the facility can identify legal/authorized contacts and responsible parties. If both parent/guardian sections are blank or the responsible party is missing, flag as incomplete.
12
LIC 700 — Emergency contacts and authorized pickup entries have minimum required data
For each listed authorized pickup person and additional emergency contact, validate that name, address, telephone, and relationship are present, and that phone numbers are in valid format. The form states the child will not be released without written authorization, so incomplete entries create operational and safety risk. If any listed contact is missing required fields, either require completion or remove the entry before acceptance.
13
LIC 700 — Physician and dentist information required or explicitly unavailable
Validate that physician and dentist fields include at least a name and contact/address, plus medical plan and number if provided by the form, or an explicit “None/Unknown/Not assigned” indicator if not available. This information is needed for emergency coordination and continuity of care. If left blank without an explicit indicator, flag for follow-up.
14
Parents’ Rights Acknowledgement (LIC 995A) — Child name, family child care home name, signature, and date required
Ensure the acknowledgement includes the child’s name, the name of the family child care home, the parent/authorized representative signature, and the date. This is the proof that required rights and disclosures were provided to the parent/representative. If any element is missing, the acknowledgement is not defensible in compliance reviews and should fail validation.
15
Immunization Record (CDPH 286) — Pupil identification and SSID format (if provided)
Validate that the pupil name, birthdate (MM/DD/YYYY), parent/guardian name, and gender are completed, and that SSID (if provided) is exactly 10 digits. Correct identification prevents misfiling immunization status and ensures accurate compliance reporting. If birthdate is invalid or SSID is malformed, reject or route for correction.
16
CDPH 286 — Vaccine dose date format and chronological logic
Ensure each recorded vaccine dose date follows the required format (MM/DD/YY) and is a valid date not in the future, and that dose sequences for a vaccine are non-decreasing (dose 2 cannot precede dose 1, etc.). This prevents data entry errors that could incorrectly mark a child as compliant or noncompliant. If invalid or out of order, flag the specific vaccine row for correction.
17
CDPH 286 — Status of Requirements section mutually exclusive selection and required supporting fields
Validate that within the applicable row (Pre-K, TK/K-12, and/or 7th Grade), exactly one status is selected (e.g., Has All Required Vaccine Doses vs conditional vs overdue vs temporary exemption vs other), and that staff initials and required dates are present. If conditional/temporary/overdue is selected, require follow-up date(s); if requirements are met, require “Date Requirements Met.” If multiple statuses are checked or required dates/initials are missing, the record should fail validation.
18
Individual Infant Sleeping Plan (LIC 9227) — Infant info and contact phone format validation
Validate that the infant’s name, gender, birth date, primary authorized representative name, and primary phone number are completed, and that phone numbers match an acceptable 10-digit format. This plan is used for safe sleep practices and rapid contact if issues arise. If key identity/contact fields are missing or phone numbers are invalid, the plan should be rejected as incomplete.
19
LIC 9227 — Rolling ability dates and signature dependencies
If Section C indicates the infant can roll, require a valid “beginning” date and the authorized representative signature/date; if Section D is completed (provider observed rolling), require provider signature/date and the follow-up authorized representative signature/date no later than the next business day (flag if later or missing). These dependencies ensure the sleep positioning plan is updated based on developmental milestones and documented appropriately. If dates are invalid, missing, or inconsistent with the required timing, route for correction/compliance review.
20
LIC 9227 — Medical exemption documentation required when exemption is 'Yes'
If the medical exemption is marked “Yes,” require attached physician instructions including sleep position, duration/expiration, physician contact information, and physician signature/date, and ensure the authorized representative certification signature/date is present. This is critical because alternate sleep positioning without proper medical authorization is a safety and regulatory risk. If any required document element is missing, the exemption should be treated as not valid and the submission should fail validation until corrected.
Common Mistakes in Completing CA Child Care Licensing Forms (LIC/CDPH)
People often skip the checkbox or check the wrong option because the two statements look similar and include multiple conditions (school-age child, age 6+, infant limits). This can create a mismatch between the facility’s license type and what the parent was notified about, which can trigger compliance issues during audits. To avoid this, confirm the facility license type first, then check only the applicable box and ensure the conditions described match the facility’s actual staffing and enrollment situation.
The form instructs to print the facility address, but many people either forget it or put it on the receipt portion instead. Missing or misplaced facility address information makes the notification hard to tie to a specific licensed location, especially for providers with multiple sites or similar names. Always complete the “PRINT FACILITY ADDRESS” area on the top half before giving it to the parent, and verify it matches the licensed address on file.
A common error is obtaining a signature but leaving the parent name line, child’s name, or date blank because the signature feels “good enough.” This weakens the record because it becomes difficult to prove which child/family received the notice and when, which matters for licensing reviews. Ensure the parent/authorized representative prints their name (if a line exists), signs, dates, and the child’s full name is entered before filing it in the child’s record.
Several forms include “cut/detach” and retention instructions, and people frequently file the wrong half or give the wrong copy to the parent. This leads to missing documentation in the child’s file or parents not receiving required notices, both of which can be cited in inspections. Follow the instruction literally: provide the specified upper/top portion to the parent and maintain the signed acknowledgement/bottom portion in the child’s record.
Parents/providers sometimes complete the affidavit even when the facility does carry liability insurance, or they leave the licensee name, child name, or facility name blank. This creates contradictory records and can cause confusion about coverage and compliance with the requirement to either carry insurance/bond or keep the signed statement. Use LIC 282 only when the provider does not carry the required liability insurance/bond, and fill in the child’s name, licensee’s name, and family child care home name exactly as licensed.
Section B is often overlooked because it is conditional and the wording is long, so people assume it’s optional. If the licensee does not own the premises or is in an HOA/condo, failing to complete Section B means parents were not properly informed about potential limits of the property owner/HOA insurance coverage. Confirm the property situation first; if Section B applies, complete it fully and obtain the required parent/guardian signature and date.
On LIC 627, the consent statement is only valid if it clearly identifies the facility authorized to obtain care and the child receiving care, but these fields are frequently left blank. In an emergency, incomplete identification can delay treatment decisions or create legal uncertainty about consent. Always enter the facility name and the child’s full legal name exactly as used in enrollment records before the parent signs and dates.
Families often write “none” inconsistently, leave the medication allergy line blank, or provide only one phone number, assuming staff can “look it up later.” Missing allergy and contact details can lead to unsafe care decisions and delays reaching a parent during urgent situations. Write a clear allergy status (e.g., “No known medication allergies (NKDA)” if applicable), provide current address, and include multiple reachable numbers (home, work, cell if allowed) with area codes.
A frequent mistake is listing only first names (e.g., “Grandma”), omitting phone numbers, or failing to include relationships, which makes it hard to verify identity at pickup. This can result in the child not being released to an authorized person or, worse, being released without adequate verification. List each authorized person’s full legal name, relationship to the child, and a current phone number; update the list immediately when circumstances change.
Because LIC 700 has many similarly formatted lines, people often put the child’s address under a parent section, swap mother/father fields, or leave “person responsible for child” blank when it differs from the parents. These errors can cause confusion about legal responsibility and where to contact or bill, and they complicate emergency response. Carefully follow each labeled block (child, father/guardian, mother/guardian, responsible person) and ensure addresses and phone numbers correspond to the correct individual.
Staff/parents commonly enter dates in the wrong format (not MM/DD/YY), omit historical doses, or forget to complete the “Status of Requirements,” staff initials, and “Date Requirements Met.” This can lead to incorrect admission decisions, missed follow-up deadlines for conditional admission, and compliance findings during school/child care reviews. Record every dose date exactly as documented, use the required date format, and always complete the status row (including follow-up dates when conditional/temporary exemption applies) with staff initials and the date requirements were met.
Families often guess the roll-over date, leave Section C blank, or fail to complete the provider observation and follow-up parent signature in Sections D/C, especially because the form spans two pages. Incomplete rolling documentation can create noncompliance with safe sleep requirements and confusion about how the infant should be placed to sleep. Enter the date the infant began rolling only when it is actually observed/known, ensure the provider signs and dates the observation, and obtain the authorized representative signature no later than the next business day after the provider’s observation.
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