Enrollment and Other Forms

State required enrollment forms
Identification And Emergency Information LIC 700 (8.08)
Child's Preadmission Health History - Parent's Report LIC 702 (8.08)
Physician's Report LIC 701 (8.08)
Child Care Center - Notification Of Parents' Rights LIC 995 (9.08)
Personal Rights LIC 613A (8.08)
Consent For Emergency Medical Treatment LIC 627 (9.08)
Other Forms
Nebulizer Care Consent Verification LIC 9166 (2.01)
This form is a state licensing requirement only if your child requires Nebulizer Care while in our care.  If so, we also require a specific written instruction from the child’s physician annually that contains all of the following information:   
  1. Specific indications for administering the medication pursuant to the physician’s prescription.   
  2. Potential side effects and expected response.   
  3. Dose-form and amount to be administered pursuant to the physician’s prescription.   
  4. Actions to be taken in the event of side effects or incomplete treatment response pursuant to the physician’s prescription.   
  5. Instructions for proper storage of the medication.   
  6. The telephone number and address of the child’s physician.   
  7. These instructions shall be updated annually. 
AB 2370 Lead Bill Flyer CCLPO2
Health and Safety Code requires all licenses Child Care Centers to provider parents and guardians of enrolled children with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. 
NOTE: There are other required forms that are needed for enrollment.

These forms are available at our school as they are updated often.

Little Scholars Academy

of California

1510 West Almond Avenue

Orange, CA 92868


Tel: 714-634-8118

Fax: 714-634-3757

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