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Child in Care Statement Receipt - CCL-3900 - Word

Child in Care Statement Receipt - CCL-3900 - Word-2026

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The document is a 'Child in Care Statement/Receipt' from the Michigan Department of Licensing and Regulatory Affairs, outlining the responsibilities and rights of parents or guardians regarding child care. It includes sections on receipt of rules, health status, immunization status, notices about the home environment, and food agreements. Parents must acknowledge understanding of licensing rules, provide health information about their children, and consent to emergency medical treatment. The document emphasizes compliance with safety regulations and proper documentation.

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Click ‘Get Form’ to open the Child in Care Statement Receipt - CCL-3900 in our editor.
Begin by entering the child(ren)’s name(s) in the designated field at the top of the form. Ensure you include the last name, first name, and middle initial for accuracy.
In Section 1, carefully read through each rule and policy. Initial next to each statement to confirm receipt and understanding. This section is crucial for compliance with licensing requirements.
Proceed to Section 2, where you will need to provide health status information. Indicate whether your child(ren) has any health conditions that may pose risks and complete the immunization status section as required.
In Section 3, check applicable boxes regarding notices about immunizations, pets, firearms, and other relevant information. This ensures transparency between you and the licensee.
Finally, complete Section 4 by certifying your understanding of the food agreement if applicable. Sign and date where indicated to finalize the document.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (42 Votes)
2021	4.4 Satisfied (42 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to write a letter for proof of child care?

I am writing to confirm that I am providing childcare for my child, [Childs Full Name], born on [Date of Birth], residing at [Childs Address]. This letter serves as official proof of the childcare arrangements in place.

How to make a receipt for child care?

This information includes: The name of the person the receipt is for. The name of the child receiving daycare services. The amount received for childcare services. The dates covering the childcare services. Your name or your daycare businesss name. Your daycare centers address. Your Employer Identification Number (EIN)

What to write about child care?

Childcare Essays (Page 1) Concept of an Inclusive Environment within Early Learning and Care Settings. Strategies of the PLF to Foster Resilience in a Child. Assessment of Co-Sleeping: Positives and Negatives. Planning a Play Activity for Early Childhood Education. Childrens Well-being in Relation to Current Frameworks.

How to provide proof of child care expenses?

If you are unable to get a W-10 you will need the following documents from the childcare provider: social security card, a copy of the providers W-4 or employee withholding certificate if they are a household employee, a copy of the statement furnished by your employer if they provide the service, and a recently

How to write a letter stating you babysit?

A Few Important Rules To Keep In Mind Start your letter with a formal salutation, such as Dear Ms. Provide a brief introduction of yourself and describe your experience with childcare. Highlight any special skills or certifications that you possess. Explain why you are passionate about working as a babysitter.

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How do I write a proof of child care letter?

What information should be included in a proof of child care letter? The letter should include the childs full name, caregivers name and contact information, dates of care, the nature of care provided, and the caregivers signature and date.

Child in Care Statement Receipt - CCL-3900 - Word-2026

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