California Child Care Center License Application Form

Submit the completed form along with all required attachments to the California Department of Social Services at their designated physical or email address. Alternatively, forms may be faxed to the provided fax number. Ensure all information is accurate to prevent delays.

The form must be submitted according to licensing timelines established by the California Department of Social Services. Please refer to their official schedule for specific deadlines in 2024 and 2025.

The purpose of the child care center license application form is to ensure that all child care facilities in California comply with state regulations. By completing this form, applicants provide essential information about their operations, ensuring they meet legal and safety standards. This process protects the welfare of children and ensures a high standard of care.

• 1. Applicant's Name: Enter the full legal names of the individuals or organizations responsible for the facility.
• 2. Requested Action: Check the appropriate box to specify the type of application being submitted.
• 3. Applicant Address: Provide the legal home address of the applicant and headquarters address for corporations.
• 4. Facility Name: Enter the name designated for the child care facility under application.
• 5. Facility Address: Input the physical location address of the facility.
• 6. Mailing Address: Provide the address where all correspondence should be sent.
• 7. Person in Charge: Enter the name and title of the person who will supervise the facility.
• 8. Type of Facility: Check the appropriate box for the type of child care facility.
• 9. Requested Capacity and Age Range: Specify the total number of children and age range for care at the facility.
• 10. Non-Ambulatory Care: Check the box and enter the number of non-ambulatory children being cared for.
• 11. Days and Hours of Operation: Outline the days and hours the facility will be in operation.
• 12. Property Ownership: Indicate whether the property is owned, rented, or specify another arrangement.
• 13. Previous Licensing: State if the facility was previously licensed and provide relevant details.
• 14. Construction Requirements: Identify if major construction or building changes are required for the facility.
• 15. Water Source: Specify if the water source for the facility is public or private.
• 16. Other Facilities: List other community care or health facilities owned or operated by the applicant.
• 17. Compliance Statement: Acknowledge understanding of licensing responsibilities and compliance with regulations.
• 18. Signatures: Include signatures of all applicants or authorized persons, with dates and titles.

Failing to submit this form correctly can result in delays or denial of the license application.

• Non-Compliance: Operating without proper licensing can lead to legal consequences.
• Operational Delays: Delays in approval may affect planned operations and child care services.

• 1. New Application: Submit when applying to start a new child care facility.
• 2. Change of Capacity: Use to modify the number of children the facility is licensed to care for.
• 3. Change of Location: Complete when relocating the child care facility to a new address.
• 4. Change of Ownership: Required for changes in the ownership structure of the facility.
• 5. Facility Modifications: Necessary when there are significant changes to the facility's structure or operations.