Lic 9040 spanish-2026

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The document is a notice from the California Department of Social Services regarding a form change for the Child Care Facility Roster (LIC 9040) effective from October 2005. It outlines the requirements for maintaining a current roster of children in care, including necessary information about each child and their guardians. The notice specifies the disposition of old forms, instructions for using the new form, and provides contact information for obtaining additional copies.

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Click ‘Get Form’ to open the lic 9040 Spanish document in the editor.
Begin by entering the 'Facility Name' at the top of the form. This identifies your child care facility.
Next, input the 'Facility License Number' to ensure compliance with licensing requirements.
In the section labeled 'Child’s Name/Birthdate', list each child's name along with their birthdate for accurate record-keeping.
Fill in the 'Address' field for each child, ensuring it is current and correct.
Provide the names and daytime phone numbers of parents or guardians in the designated fields.
Lastly, include the physician's name and phone number, as well as dates for enrollment and departure for each child.

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