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DSS enrolment forms for preschools and daycares- Enroll Now
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Preschool Enrollment Forms

Child’s Records

  • Identification and Emergency Information – Child Care Centers (LIC 700)
  • Child’s Preadmission Health History – Parents’ Report (LIC 702)
  • Child’s Preadmission Health Evaluation if not enrolled in a public or private elementary school – Physician’s Report (LIC 701)
  • Consent for Medical Treatment (LIC 627)
  • Written statement from parent(s) or authorized representative exempting child from medical assessment, immunizations, and treatment because of adherence to a religious faith that practices healing by prayer or other spiritual means; or physician’s statement that immunization is not indicated.
  • California School Immunization Records (“blue cards”, PM 286) for non-school-age children
  • Current Admission Agreement, with authorized signature(s).
  • Centrally Stored Medication and Destruction Record (LIC 622) , if medications are handled.
  • Document of unusual behavior or signs of illness.
  • Unusual Incident/Injury Report (LIC 624)
  • Signed and dated receipt of Notification of Parents’ Rights (LIC 995)
  • Infant needs and services plan (for infant centers).
  • Toilet-training plan (for infant centers).
  • Infant-feeding plan (for infant centers).
  • Personal Rights — Community Care Facilities, Child Care Facilities (LIC 613A)receipts, signed and dated.
  • Authorizations for dispensing medication, signed by each child’s authorized representative.
  • Documentation required for health-related services (e.g., blood-glucose monitoring and nebulizer care).(LIC 9166)
  • Gastrostomy Tube Care: Physician’s Checklist (LIC 701A)
  • Acknowledgement of receipt of licensing reports (LIC 9224) , if applicable

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Or Call 408-320-2149 , 408-685-2261