Written Documentation Acknowledgement

WRITTEN INFORMATION PACKET DOCUMENTATION
Michigan Department of Licensing and Regulatory Affairs
Bureau of Community and Health Systems
Child(ren's) Name(s) - Last, First*
A written information packet has been provided at the time of enrollment. The packet included all the following information:
- Criteria for admission and withdrawal
- Schedule of operation, denoting hours, days, and holidays during which the center is open and services are provided
- Fee policy
- Discipline policy
- Food service program
- Program philosophy
- Typical daily routine
- Parent notification plan for accidents, injuries, incidents, illnesses
- Exclusion policy for child illnesses
- Notice of the availability of the center’s licensing notebook
- The licensing notebook contains all the licensing inspection and special investigation reports and related corrective action plans since May 28, 2010
- The licensing notebook is available to parents during regular business hours
- Licensing inspection and special investigation reports from at least the past two years are available on the child care licensing website at www.michigan.gov/michildcare
I certify that I received all of the above items.
Parent / Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY
Digital Signature Acknowledgement*
- By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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