Child Information Record (BCAL-3731 Rev. 7-18)
State of Michigan - Department of Licensing and Regulatory Affairs - Child Care Licensing
INSTRUCTIONS: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, "UNKNOWN" or "NONE" is the response required. A blank field, a line through a field or "N/A" are NOT acceptable responses.
ONE FORM PER CHILD
For Provider Use Only: Date of Admission Date of Discharge