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Get CA LIC 9040 1999

841 requires that each child care facility maintain a current roster of children who are provided care in the facility. STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES CHILD CARE FACILITY ROSTER RETAIN FOR 3 YEARS CHILD CARE CENTERS INFANT CARE CENTERS SCHOOL AGE CENTERS AND FAMILY CHILD CARE HOMES FACILITY NAME CHILD S NAME/ BIRTHDATE LIC 9040 ENG/SP 7/99 NOTE Health and Safety Code Section 1596. The roster shall include the child s name address names and day phone numbers of the parent s or guardian s and name and phone number of the child s physician* This is an optional form that may be used for this purpose. FACILITY LICENSE NUMBER ADDRESS This roster must be kept in a central location at the facility updated as needed and made available to the licensing agency upon request. The roster shall include the child s name address names and day phone numbers of the parent s or guardian s and name and phone number of the child s physician* This is an optional form that may be used for this purpose. FACILITY LICENSE NUMBER ADDRESS This roster must be kept in a central location at the facility updated as needed and made available to the licensing agency upon request. .

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