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3 Day Absence Form

The policy and procedure below is based on Child Care Services Provider Manual, Chapter 7: Keeping Attendance Records.

When Contract-Referred Children Are Absent and Parents Don't Call

Parents of contractor-referred children are required to notify the provider every time their children are absent from care. When contractor-referred children are absent three days in a row without parent notice, the provider must notify Child Care Services to report the absence on the third day of absence.

Child Care Service Staff will notify the provider on the fifth day to find out if the child has returned or if the parent has called the provider about the child's absence.

When a contractor –referred child does not attend child care for five days in a row without the parent notifying the provider, Child Care Services terminates the child's enrollment effective the end of the fifth day.

Providers are paid for these five days if they have followed the procedure and notified Child Care Services on the third day the child is absent, as required.

Provider Information

Required FieldIndicates Required Field
Required FieldProvider Name: Required Field
Required FieldProvider License Number: Provider Number Required Numbers Only
Required FieldProvider Phone Number: Required Field
Required FieldThe following information is being submitted by: Required Field

Case Information

Required FieldParent/Guardian Name: Required Field  
Required FieldCase # Required Field Numbers Only  
Required FieldCCAA Child # Numbers Only add

Days without Contact

Document Days Absent 1
Date 1:
Document Days Absent 2
Date 2:
Document Days Absent 3
Date 3:
 
Today's Date: 02/06/2012  

Days Authorized Based on 2450:

Required Field 2450 Authorization for Care states:  (Check days that apply)Selection Required

If Days Vary, Please check how many days are varied

Or, if the days authorized are varied; How Many: