LIC 9040 - Child Care Facility Roster

Form LIC 9040 is used to maintain a roster of children enrolled in child care facilities in California. The form is completed by facility staff and includes information such as each child's name, date of birth, parent/guardian contact information, emergency contacts, authorized pick-up persons, and any relevant medical or allergy information. By utilizing this form, child care facilities ensure accurate record-keeping, track attendance, support communication during emergencies, and comply with licensing regulations related to child care administration.