Children’s Products Certification
Name of Child Care Center/Home_______________________________________
As of ______________________________________________________________
I certify that all bulletins and notices issued by the United States Consumer
Product Safety Commission regarding unsafe children’s products have been
reviewed.
I also certify that there are no unsafe children’s products in the center or home
except for the following:
A product that is antique or collectible children’s products and is not used
by, or accessible to any child
An unsafe children’s product that is being retrofitted to make it safe and
the product is not used by, or accessible to any child.
______________________________________
____________________
Signature
Date Signed
_______________________________________
Name of person signing form (please print)
Role at center/home
(please check appropriate box):
Permit holder/primary caregiver
Governing body designee
Director
Other _________________________________