Family Child Care Home Notification of Parents’ Rights

Please review and complete the following form to acknowledge receipt of the "Family Child Care Home Notification of Parents' Rights":

1. Parent/Authorized Representative Rights (read-only information):

You have the right to:
- Enter and inspect the family child care home without advance notice whenever children are in care.
- File a complaint against the licensee with the licensing office and review the licensee’s public file.
- Review reports of licensing visits and substantiated complaints from the last three years.
- Be notified of any person not allowed in the child care home.
- Request, in writing, that another parent not visit or take your child from the home (with a court order).
- Be informed of any adult with a criminal record exemption and the facility’s liability insurance status.

2. Licensing Office Information (read-only):

Licensing Office Name

Licensing Office Address

Licensing Office Telephone *

Read Only *

Separate email addresses with a comma.

3. Parent/Authorized Representative Acknowledgement:

Child’s Name *

Name of Family Child Care Home *

Parent/Authorized Representative Name *

Confirmation *

checkbox for confirmation

Date *

I have filled out the following forms

Family Child Care Home Notification of Parents’ Rights

Caregiver Background Check Process form

Family Child Care Consumer Awareness Information form

Opportunity *

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PARENT ACKNOWLEDGEMENT

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