CHILD CARE CENTER NOTIFICATION OF PARENTS’ RIGHTS
As a Parent/Authorized Representative, you have the right to:
Licensing Office Name: Community Care Licensing
Licensing Office Address: 101 Golf Course Dr. A-230, Rohnert Park, CA 94928
Licensing Office Telephone #: 707) 588-5026
NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE POSES A RISK TO CHILDREN IN CARE.
For the Department of Justice “Registered Sex Offender”database, go to www.meganslaw.ca.gov
LIC 995 (12/06) (Detach Here - Give Upper Portion to Parents)
(Parent/Authorized Representative Signature Required)
I, the parent/authorized representative of , have received a copy of the “CHILD CARE CENTER NOTIFICATION OF PARENTS’ RIGHTS” and the CAREGIVER
BACKGROUND CHECK PROCESS form from the licensee.
Calpella State Preschool
Name of Child Care Center
Signature (Parent/Authorized Representative) Date
NOTE: This Acknowledgement must be kept in child’s file and a copy of the Notification given to parent/authorized representative.
For the Department of Justice “Registered Sex Offender”database go to www.meganslaw.ca.gov
LIC 995 (12/06)