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Downloadable Forms
in PDF Click on the forms below to view or download. Form #13
Work Day and Committee Request Form #14 Committee
Descriptions 09-10 Form #15 –
Photo Release Agreement
09-10 Online Forms The
remaining forms can be found on the following website: (Hold
down Shift then click on this link to open in new window) http://www.cdss.ca.gov/cdssweb/PG166.htm#l The
forms we need are: Form
#4: LIC 702 (Parent’s Health
Report) Form
#5: LIC 701 (Physician’s Health
Report) Form
#6: LIC 700 (ID & Emergency
Information Sheet) Form
#8: LIC 613A (Personal Rights)* Form
#9: LIC 995 (Parents’ Rights)* Form
#11: LIC 627 (Consent for Emergency Medical
Treatment) Form
#12:LIC 995E (CA Caregiver Background Check) Online Form Instructions: All
of the online forms can be filled out online prior to printing, or they can
be printed blank and filled in by hand. * For CNS Forms #8 (LIC 613A) and #9 (LIC
995A), enter the following agency name, address, and phone number on the
first three lines: Community
Care Licensing (530)
895-5033 Note:
Only the lower portions of these two forms need to be returned to CNS. Form
#12 (LIC 995E) is informational only and does not need to be returned with
the other forms. |
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