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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), page 1

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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.

Fillable fields136

Pages9

Sections38

Questions that depend on earlier answers6

Form Complexity IndexComplex, 63/100

The AI checks your answers before you download

20 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

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.

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.

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.

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.

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.

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.

And 14 more checks

Emergency Medical Consent (LIC 627) — Facility name and child name required
LIC 627 — Home address and phone number format validation
LIC 627 — Medication allergies field must be explicitly completed (value or 'None')
Identification & Emergency Information (LIC 700) — Child identity fields complete and consistent
LIC 700 — Parent/guardian and responsible party information completeness
LIC 700 — Emergency contacts and authorized pickup entries have minimum required data
LIC 700 — Physician and dentist information required or explicitly unavailable
Parents’ Rights Acknowledgement (LIC 995A) — Child name, family child care home name, signature, and date required
Immunization Record (CDPH 286) — Pupil identification and SSID format (if provided)
CDPH 286 — Vaccine dose date format and chronological logic
CDPH 286 — Status of Requirements section mutually exclusive selection and required supporting fields
Individual Infant Sleeping Plan (LIC 9227) — Infant info and contact phone format validation
LIC 9227 — Rolling ability dates and signature dependencies
LIC 9227 — Medical exemption documentation required when exemption is 'Yes'

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How to Fill Out CA Child Care Licensing Forms (LIC/CDPH) Online for Free in 2026

What the AI walks you through.

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.
Enter facility and child identifiers where applicable (facility name/address; child’s full name; admission date; parent/authorized representative names and contact details).
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).
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.
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.
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.
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).

Common Mistakes in Completing CA Child Care Licensing Forms (LIC/CDPH)

The ones the AI is built to catch.

Not checking the correct “Small” vs “Large” Family Child Care Home box (LIC 9150)

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.

Leaving the facility address blank or writing it in the wrong section (LIC 9150 top half)

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.

Parent receipt section missing key identifiers (parent name, child name, date) (LIC 9150 bottom half)

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.

Confusing who keeps which portion of the form (detach/cut instructions ignored)

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.

Liability insurance affidavit completed incorrectly (LIC 282) — using it when insurance exists or leaving blanks

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.

Skipping Section B on LIC 282 when it applies (non-owner/HOA/condo situations)

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.

Emergency medical consent missing the facility name or child name (LIC 627)

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.

Incomplete allergy and contact information on LIC 627 (allergies, home/work phone, address)

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.

Authorized pickup list incomplete or too vague (LIC 627 / LIC 700)

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.

LIC 700 identification fields mixed up (parent/guardian names, responsible person, addresses, dates)

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.

Immunization record errors: wrong date format, missing doses, or not completing status/initials (CDPH 286)

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.

Infant Sleeping Plan not updated when rolling begins or missing required signatures (LIC 9227)

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.

Frequently Asked Questions About CA Child Care Licensing Forms (LIC/CDPH)

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How does the AI fill out CA Child Care Licensing Forms (LIC/CDPH)?

You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of CA Child Care Licensing Forms (LIC/CDPH), on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.

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How complex is CA Child Care Licensing Forms (LIC/CDPH) to fill out?

CA Child Care Licensing Forms (LIC/CDPH) has a Form Complexity Index of 63 out of 100, in the complex tier: 136 fillable fields across 9 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.

What is the purpose of the “Parent Notification – Additional Children in Care” (LIC 9150) form?

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.

Who needs to receive and sign the LIC 9150 notification?

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.

How do I know whether the provider is a Small or Large Family Child Care Home on LIC 9150?

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.

What are the conditions that allow a Small Family Child Care Home to care for up to 8 children?

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.

What are the conditions that allow a Large Family Child Care Home to care for up to 14 children?

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.

What does the parent sign on the LIC 9150 receipt section, and where is it kept?

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).

What is the “Affidavit Regarding Liability Insurance” (LIC 282) used for?

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.

Do providers have to carry liability insurance, and what if they don’t?

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.

When is Section B of LIC 282 required?

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.

What is the “Consent for Emergency Medical Treatment” (LIC 627) and who signs it?

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.

What information is required on the Identification and Emergency Information form (LIC 700)?

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.

What are “Parents’ Rights” (LIC 995A) and what do I sign?

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.

What is the California Pre-Kindergarten and School Immunization Record (CDPH 286) used for?

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.

What does “conditional admission” mean on CDPH 286?

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.

What is the Individual Infant Sleeping Plan (LIC 9227) and when is it required?

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.

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