Looking for a U.s. Department Of Education Forms And Templates? Download it for free!

MARYLAND STATE DEPARTMENT OF EDUCATION

Office of Child Care-Licensing Office

ON CALL AGREEMENT

Child Care Centers and Large Family Child Care Homes

Child Care Center and Large Family Child Care Regulations state, “If the only children in attendance at the center

are 2 years old or older and only one staff member is needed to meet staff/child ratio requirements, the operator

shall have a written, signed, and dated agreement from an adult who has successfully passed a federal and State

criminal background check and a review of child abuse and neglect records and is willing and able to be at the

center within 15 minutes of notification.”

Name of On Call Adult: __________________________________________________________________________

(First, Middle, Maiden, and Last)

Address: ______________________________________________________________________________________

City: _________________________________________________ State: _________________ Zip Code: ________

Phone #: _______________________________Social Security #:_____________________ Date of Birth: ________

Center Operator’s Name: ________________________________________________________________________

Center Address: _______________________________________________________Phone:___________________

City: ___________________________________________ State: _________________ Zip Code: ______________

YES

I understand that I must submit criminal background check forms to CJIS and a notarized release

of information form to OCC.

I understand that I cannot be used as an on-call on call adult until OCC Licensing Office completes

the required clearances for my approval and I have successfully passed a federal and State

criminal background check.

I will be on-call at the center named above during the center’s operating hours. I understand this

means I am available to supervise the children in the event of an emergency.

I am at least 18 years of age and physically and mentally capable of providing care for children.

For Child Care Center: I have read the center child care regulations and agree to follow them. (See

below link for the Center Child Care regulations.

546C5641F978/31469/Sub16CTRamend012312.pdf

For Large Family Child Care Homes: I have read the large family child care homes regulations and

agree to follow them. (See below link for the Center Child Care regulations.

546C5641F978/31464/13A18_LFCCH_eff020612.pdf

Have successfully completed a Federal and State criminal background checks.

If this agreement should change, I will provide written notification to the Child Care Center Director and the

Office of Child Care immediately. The OCC Licensing Specialist Number is: ________________________________

I certify that the information on the form is correct and true.

_____________________________________

___________________________________

Center Director (printed name)

On-Call Adult/Substitute (Printed name)

_____________________________________

___________________________________

(Signature)

___________________________________

____________________________________

(Date)

On Call Agreement Child Care Centers And Large Family Child Care Homes Form - Maryland State Department Of Education

Related Articles

Related forms

Related Categories