UTILITY SHUT OFF -Indicate locations on the Facility Sketch (LIC 999A) with the exit routes. The Division of Professional Licensure (DPL) oversees 39 boards, which license and regulate more than 167 trades and professions in Massachusetts. %PDF-1.4 %���� 7. yes no if yes, what kind and any side effects: if yes, at what stage: are bowel movements regular? trailer << /Size 67 /Info 22 0 R /Encrypt 26 0 R /Root 25 0 R /Prev 23001 /ID[] >> startxref 0 %%EOF 25 0 obj << /Type /Catalog /Pages 11 0 R /JT 21 0 R /PageLabels 10 0 R /AcroForm 28 0 R /PageLayout /SinglePage /OpenAction 27 0 R /ViewerPreferences << /CenterWindow true >> /Metadata 23 0 R >> endobj 26 0 obj << /Filter /Standard /R 2 /O (?�i�~�|i���v-����:��`�rw`W) /U (�p����J�����2���LS9��>�U1���) /P -12 /V 1 /Length 40 >> endobj 27 0 obj << /S /GoTo /D [ 29 0 R /Fit ] >> endobj 28 0 obj << /Fields [ 1 0 R 33 0 R 35 0 R 37 0 R 2 0 R 41 0 R 3 0 R 45 0 R ] /DR 60 0 R /DA (�G���Aw+�VV�) >> endobj 65 0 obj << /S 36 /T 119 /V 161 /L 197 /Filter /FlateDecode /Length 66 0 R >> stream LIC 9166 Nebulizer Care Consent/Verification. 'uj����m���%,) /DR 60 0 R /AP << /N 38 0 R >> >> endobj 38 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 183.47113 18.18182 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000013280 00000 n Health Insurance Premium Payment Application (SP) California Children's Services (CCS) The following are applications to enroll children and pregnant women in the Medi-Cal or Healthy Families program. Submission Editing. title: lic 995e.pdf author: ca dept of social services created date: This list is an aid to LIC 311D Forms/Records to Keep in Your Family Child Care Homes. 0000006092 00000 n Lic. yes no if yes, name of doctor: does child take prescribed medication(s)? %PDF-1.6 %���� 0000002231 00000 n 0000000016 00000 n 0000001443 00000 n 0000001613 00000 n Please make a habit of researching and checking the Department of Social Services (DSS) web site and ours for updates. See authoritative translations of 916 in Spanish with example sentences and audio pronunciations. This time-saving tool is perfect for nursery schools, child development programs, after-school programs and early childhood care centers. Vehicle (or license) plates are a metal plate attached to a vehicle or trailer for official identification purposes. 0000008327 00000 n 24 0 obj << /Linearized 1 /O 29 /H [ 1766 281 ] /L 23609 /E 19315 /N 1 /T 23011 >> endobj xref 24 43 0000000016 00000 n %%EOF ESTABLISH A COORDINATED RESPONSE PLAN INVOLVING ALL OF THE FOLLOWING: C. CHILD CARE PERSONNEL AND LOCAL … 0000002972 00000 n Our Scheddule: Monday-Friday. Want to check that a business or individual the DPL oversees has a valid license or permit? �|o����� endstream endobj 39 0 obj << /Type /Annot /Subtype /Widget /Rect [ 465.2894 93.65262 606.61176 112.66089 ] /F 4 /P 29 0 R /AP << /N 40 0 R >> /Parent 2 0 R >> endobj 40 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 141.32236 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000002614 00000 n 0000002685 00000 n ��hÁOC�H endstream endobj 47 0 obj << /ProcSet [ /PDF /Text ] /Font << /F2 48 0 R /F6 54 0 R /F7 52 0 R >> /ExtGState << /GS2 64 0 R >> >> endobj 48 0 obj << /Type /Font /Subtype /Type1 /FirstChar 32 /LastChar 181 /Widths [ 278 278 355 556 556 889 667 191 333 333 389 584 278 333 278 278 556 556 556 556 556 556 556 556 556 556 278 278 584 584 584 556 1015 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 778 722 667 611 722 667 944 667 667 611 278 278 278 469 556 333 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 556 333 500 278 556 500 722 500 500 500 334 260 334 584 350 0 350 0 0 0 0 0 0 0 0 0 0 0 350 0 350 350 0 222 0 0 350 556 0 0 0 0 0 0 350 0 0 278 0 556 556 0 0 0 0 0 737 0 0 0 333 0 0 0 584 0 0 0 556 ] /Encoding /WinAnsiEncoding /BaseFont /GKNECO+Helvetica /FontDescriptor 49 0 R >> endobj 49 0 obj << /Type /FontDescriptor /Ascent 718 /CapHeight 718 /Descent -207 /Flags 32 /FontBBox [ -166 -225 1000 931 ] /FontName /GKNECO+Helvetica /ItalicAngle 0 /StemV 88 /XHeight 523 /CharSet (����@p�h�=��[KF'���{$g�}���0��5[���\ �.JN�����Y�Qo����\n���U�,���{�!N|k#V�_�Qh��\n��� mR�ܚ�-V���޹�\ Gۀ�&��x�0�e�h�N*#���q2��"+�\\�!\\�\\���R���D�Ž�a�o�s1�X,�I\ v��^��{Ѣ\\�w-Z) /FontFile3 63 0 R >> endobj 50 0 obj << /Length 1607 /Filter /FlateDecode >> stream Please print and fill out the following forms and bring them the first day of class. LIC 9150 Parents notification additional children in care. 0000002535 00000 n 0000009126 00000 n 0000001208 00000 n ����t��2���z��#? 0000004349 00000 n w뵧$��}IOy���G:K��ک"i�/������T���﷖28�0u,��_�`ш�뵅��f�Ѷ�+i�5�}���͊Y����{�Ɔ�ĉD��7�}� �'�2H)��30� 7/Ւ�CY����eoi���#��հF��Mq endstream endobj 66 0 obj 155 endobj 29 0 obj << /Type /Page /Parent 11 0 R /Resources 47 0 R /Contents 50 0 R /Thumb 4 0 R /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 /Annots 30 0 R >> endobj 30 0 obj [ 31 0 R 33 0 R 35 0 R 37 0 R 39 0 R 41 0 R 43 0 R 45 0 R ] endobj 31 0 obj << /Type /Annot /Subtype /Widget /Rect [ 38.01654 582.90897 265.28934 601.91724 ] /F 4 /P 29 0 R /AP << /N 32 0 R >> /Parent 1 0 R >> endobj 32 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 227.2728 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000011753 00000 n There is no equivalent term in English. lic 701 (8/01) (confidential) 1st 2nd 3rd 4th 5th vaccine polio (opv or ipv) dtp/dtap/ dt/td mmr hib meningitis hepatitis b varicella (diphtheria, tetanus and [acellular] pertussis or tetanus and diphtheria only) (measles, mumps, and rubella) (required for child care only) (chickenpox) * yes no any eating problems? 0000001382 00000 n 0000001224 00000 n An abbreviation is the shortened form of a word or group of words (e.g. FIRMA DEL REPRESENTANTE AUTORIZADO FECHA DIRECCION DEL REPRESENTANTE AUTORIZADO NUMERO DE TELEFONO EN EL HOGAR NUMERO DE TELEFONO EN EL TRABAJO LIC 9166 (SP) (2/01) FORMULARIO DE CONSENTIMIENTO / VERIFICACION PARA DAR UNA MEDICINA POR MEDIO DE UN NEBULIZADOR GUARDERIAS INFANTILES b{��ѐ6�9� endstream endobj 41 0 obj << /Type /Annot /Subtype /Widget /Rect [ 31.40497 69.68567 608.26465 88.69394 ] /P 29 0 R /F 4 /T (Y������) /FT /Tx /AA << >> /DA (� ��Ɓ�Bְ) /DR 60 0 R /AP << /N 42 0 R >> >> endobj 42 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 576.85968 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream 5. ;94�8����:A$�D�6��e��Q�E��i����@l��k�@!�^›��$@� EL��6P�Y��nY�l���/_DF��6%�݋X�bZ?�QU�>�I]RO�9��. 0000002468 00000 n 0000003181 00000 n LIC 700 (SP) (8/08) (CONFIDENTIAL) A completarse por el padre/madre o el representante autorizado. Emergency Disaster Plan (LIC 610, LIC 610A and 610A (SP)) and be made accessible to the public. 0 0000003991 00000 n 0000006336 00000 n 0000002026 00000 n 0000004881 00000 n Washington, DC 20005 US. 0000001437 00000 n In the sense shown in 2), "Lic." state of california – health and human services agency california department of social services community care licensing division criminal background clearance transfer request "description":"I give my consent for the above-named LICENSEE OR STAFF PERSON, who work(s) at the above-named CHILD CARE FACILITY, to administer inhaled medication to my child and to contact my child’s health care provider. 0000004202 00000 n Complete child’s name and address information section, or ask parent or guardian to complete this section only. Las medicinas recetadas y sin receta tienen que estar en la botella … lic 627 (9/08) (confidential) work phone. `�S��L�jVy endstream endobj 45 0 obj << /Type /Annot /Subtype /Widget /Rect [ 319.66125 45.71872 605.61176 63.90054 ] /P 29 0 R /F 4 /T (�G|c�\)hѥ���W) /FT /Tx /AA << >> /DA (�gva�v-���ɥEi) /DR 60 0 R /AP << /N 46 0 R >> >> endobj 46 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 285.9505 18.18182 ] /Resources << /ProcSet [ /PDF ] >> >> stream You will receive plates when you register your vehicle for the first time. 0000017124 00000 n 9 28

In addition, I certify that I have personally instructed the above-named licensee or staff person on how to … 0000003009 00000 n 0000008857 00000 n 3y_��BtF�� endstream endobj 33 0 obj << /Type /Annot /Subtype /Widget /Rect [ 357.85135 582.90897 574.38034 601.91724 ] /P 29 0 R /F 4 /T (�C�ܥ7) /FT /Tx /AA << >> /DA (�j���%ύ�A.��JZ) /DR 60 0 R /AP << /N 34 0 R >> >> endobj 34 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 216.52899 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream Health Insurance Premium Payment Application (SP) California Children's Services (CCS) The following are applications to enroll children and pregnant women in the Medi-Cal or Healthy Families program. Translate 916. An abbreviation is the shortened form of a word or group of words (e.g. Please make a habit of researching and checking the Department of Social Services (DSS) web site and ours for updates. U4248002 Paula 6-1-00 Back INSTRUCTIONS FOR SCHOOL OR CHILD CARE STAFF 1. Application to Determine CCS Program Eligibility (DHCS 4480) Alt: Spanish CCS Special Care Center Directory Update Form (DHCS 4507) is a title of courtesy used in Spanish for someone with a bachelor's degree. 3. 0000008019 00000 n 0000012860 00000 n 0000009420 00000 n * yes no is child presently under a doctor’s care? 0000001867 00000 n lic 9166 (2/01) nebulizer care consent/verification child care facilities signature of authorized representative date address of authorized representative home telephone number work telephone number. is a title of courtesy used in Spanish for someone with a bachelor's degree. xref "UFO" = "unidentified flying object"; "p." = "page"). Home Search Homes Probate About THE SPERA GROUP Contact Us Local Schools Calculators Local Weather Relocation Home Value Request VIP Home Finder Buyer … 7. News Releases Year 2017 Current news releases from the California Department of Education's (CDE) Communications Division of the State Superintendent of Public Instruction. 9 0 obj <> endobj 0000004663 00000 n 0000003686 00000 n �ন��^���� endstream endobj 43 0 obj << /Type /Annot /Subtype /Widget /Rect [ 29.75208 45.71872 315.70258 63.90054 ] /P 29 0 R /F 4 /AA << >> /AP << /N 44 0 R >> /Parent 3 0 R >> endobj 44 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 285.9505 18.18182 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000002309 00000 n 0000002825 00000 n This list is an aid to LIC 311D Forms/Records to Keep in Your Family Child Care Homes. E���P��� endstream endobj 37 0 obj << /Type /Annot /Subtype /Widget /Rect [ 229.75214 510.18167 413.22327 528.36349 ] /P 29 0 R /F 4 /T (~}> /DA (? www.thesperagroup.us. 0000005027 00000 n There is no equivalent term in English. 0000019094 00000 n 0000014994 00000 n STATE FORMS LIC 311 D In an effort to assist our members we have provided a list of some of these required forms. … Signature Capture. ELIMINATE POTENTIAL HAZARDS IN CLASSROOMS AND THROUGHOUT THE SITE: B. 0000005861 00000 n 0000001642 00000 n In the sense shown in 2), "Lic." 0000011860 00000 n Excelsior license plates are now availableGet plates for the first timeRegister your vehicle and get plates Transfer platesYou cannot transfer your plates … 6. Todas las medicinas recetadas o sin receta se deben mantener con el nombre del niño y deben tener fecha. 5. "UFO" = "unidentified flying object"; "p." = "page"). LIC 9095 - Evaluation of Teachers’ Qualifications LIC 9096 - Evaluation of Director Qualifications *LIC 9108 - Statement Reporting Suspected Child Abuse *LIC 9148 - Earthquake Preparedness Checklist LIC 9163 - Request for Livescan Service *LIC 9166 - Nebulizer Care Consent/Verification LIC 9182 - Criminal Background Clearance Transfer Request Vehicle (or license) plates are a metal plate attached to a vehicle or trailer for official identification purposes. The Division of Professional Licensure (DPL) oversees 39 boards, which license and regulate more than 167 trades and professions in Massachusetts. 36 0 obj <>stream 0000001071 00000 n Application to Determine CCS Program Eligibility (DHCS 4480) Alt: Spanish CCS Special … LIC 9221 (SP) (8/08) HORA EN QUE SE ADMINISTRÓ FIRMA DEL MIEMBRO DEL PERSONAL FECHA: FECHA QUE TERMINA HORA DEL DÍA INSTRUCCIONES PARA EL PADRE/MADRE: 1. LIC 9221 (8/08) TIME GIVEN TIME GIVEN TIME GIVEN TIME GIVEN TIME GIVEN STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE STAFF SIGNATURE DATE: ENDING DATE TIME OF DAY PARENT’S INSTRUCTIONS: 1. Department of Health Care Services. Give parents top part and keep bottom part in record. 0000011916 00000 n EQUIPMENT LOCATION - The fire department may help you with installation information. Cut along dotted line. 0000011661 00000 n Designed for the submission of form LIC 701, this child care program app tracks important details, including parental consent, immunization history, and the licensed physician's report. 0000002047 00000 n startxref License # SP98365808. EQUIPMENT LOCATION - The fire department may help you with installation information. 0000006164 00000 n The Consent for Emergency Medical Treatment California: LIC 627 mobile app allows parents and guardians to give their informed consent for treatment by a health care provider when they are away from home. 0000010212 00000 n OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, … You will receive plates when you register your vehicle for the first time. A. lic 702 (8/08) (confidential) word used for urination* is child toilet trained? /������ >$i:�O���̥�FA�炣}���,&�E�������,��%��1;I$$��ڱK��iVL[jkS. LCAP Template Available in Spanish (En Espanol) Torlakson Announces that LCAP Template is now available in Spanish. 1515 14th Street NW. 0000001588 00000 n Spanish LIC 624B, Unusual Incident/Injury Report — Family Child Care Home (pdf; 132.03 KB) LIC 624B (SP), Reporte de incidente inusual/lesión - hogar que proporciona cuidado de niños (pdf; 128.14 KB) 0000002834 00000 n 0000016666 00000 n lic 701 (8/01) (confidential) 1st 2nd 3rd 4th 5th vaccine polio (opv or ipv) dtp/dtap/ dt/td mmr hib meningitis hepatitis b varicella (diphtheria, tetanus and [acellular] pertussis or tetanus and diphtheria only) (measles, mumps, and rubella) (required for child care only) (chickenpox) 0000001766 00000 n Please print and fill out the following forms and bring them the first day of class. U4248002 Paula 6-1-00 Back INSTRUCTIONS FOR SCHOOL OR CHILD CARE STAFF 1. UTILITY SHUT OFF -Indicate locations on the Facility Sketch (LIC 999A) with the exit routes. physician or dentist to be called in an emergency names of persons authorized to take child from the facility (child will not be allowed to leave with any other person without written authorization from parent or authorized representative) title: lic 9166 author: ca dept. Want to check that a business or individual the DPL oversees has a valid license or permit? 0000004382 00000 n 7:30 AM to 5:00 PM. lic 995 e (6/05) california department of social services important information for parents caregiver background check process california department of social services. 2. Lic. 0000002084 00000 n This form is intended to meet this requirement. Title: S�!f#�[� Author \�1 Created Date [�Pv!�J�q�@e 10 ��pU7� ���ݪ��c�� endstream endobj 35 0 obj << /Type /Annot /Subtype /Widget /Rect [ 104.95871 545.71887 571.901 564.72714 ] /P 29 0 R /F 4 /T (E8N�ȓ) /FT /Tx /AA << >> /DA (FĞ�S�E��MIn�) /DR 60 0 R /AP << /N 36 0 R >> >> endobj 36 0 obj << /Length 11 /Subtype /Form /BBox [ 0 0 466.94229 19.00827 ] /Resources << /ProcSet [ /PDF ] >> >> stream 0000003328 00000 n <<4A213ED84AE8BC40A916D2C481B5B9A3>]>> OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, radio and other emergency equipment. 0000003539 00000 n 0000006023 00000 n 0000001934 00000 n 0000004517 00000 n Contact Information. 0000005152 00000 n LIC 9224 Acknowledgment Of Receipt Of Licensing Reports. 0000002385 00000 n of social services created date: 0000002234 00000 n Excelsior license plates are now availableGet plates for the first timeRegister your vehicle and get plates Transfer platesYou cannot transfer your plates to another person. Consent/Verification for Nebulizer Care (LIC 9166 - English I Spanish) Identification and Emergency Information (LIC 700 - English I Spanish) Notification of Parents' Rights (LIC 995A - English I Spanish) Caregiver Background Check Process (LIC 995E - English I Spanish) Family Child Care Consumer Awareness Information (LIC … 0000010264 00000 n 6. lic 700 (8/08)(confidential) state of california - health and human services agency california department of social services consent for emergency medical treatment- child care centers or family child care homes as the parent or authorized representative, i hereby give consent to Stonepoint Properties 8023 Vantage Drive Suite 890 San Antonio, TX 78230 210-934-0970 Should you require assistance in navigating our website or searching for real estate, please contact our offices at 210-934-0970.. Texas Real Estate Commission Consumer Protection Notice trailer 0000017048 00000 n 0000010312 00000 n Forms Access forms used by the Department of Health Care Services. State of California—Health and Human Services Agency California Department of Public Health The California Department of Public Health places strict controls on the gathering and use of personally identifiable data. 0000004417 00000 n ���X�{7� 0000000856 00000 n Only For Children with Asthma. 0000013304 00000 n Complete child’s name and address information section, or ask parent or guardian to complete this section only. Troy Ph: 202-487-9166 Eric Ph: 202-276-3255. Features. All prescription and nonprescription medications shall be maintained with the child’s name and … 0000003707 00000 n 0000003844 00000 n STATE FORMS LIC 311 D In an effort to assist our members we have provided a list of some of these required forms.

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