Children's Cottage Child Care

Enrollments Forms

• Identification and Emergency Informatioon (Lic 700)
  Names the parents/guardians and who is authorized to pick up the child
• Parent's Report on Child's Health History (Lic 702)
  Tell us your child's health history including any allergies to food, etc.
• Consent for Emergency Medical Treatment (Lic 627)
  We keep this on file in the rare event that we have to call 911
• Personal Rights (Lic 613A)
  You keep the top, we keep the bottom in your child's file. Info for blanks: Department of Social Services, Community Care Licensing, 101 Golf Course Dr. Ste A-230, Rohnert Park CA 94928 (707) 588-5026
• Parent's Rights (Lic 995)
  You keep the top and we put the bottom in your child's file. Info for the blanks: Community Care Licensing, 101 Golf Course Dr. Ste A-230, Rohnert Park CA 94928 (707) 588-5026
• Physician's Report including child's immunizations (Lic 701)
  Physician must sign lower left of form and return to us within 30 days of your child starting
• Admission Agreement
  Print form, fill it out, and make a copy for you and one for us
• Use this to set up automatic monthly debits from your checking account (optional)
  Set up ACH Debit payments and Email information, etc
• Teacher Background Check Information (Lic 995F)
  State form with nothing to fill out. Information on Teacher background checks