Mercedes Stanley, Owner & Administrator
License No. 334-815-560
14884 Blueberry Rd
Moreno Valley, CA
92553
3 blocks to Serrano Elementary and 4
blocks Badgers Springs Middle
(951) 924-0161
Downloadable Forms: Please print and complete.
You will need Adobe Acrobat Reader to view the
files. 
Parent Forms
Stanley Child Care Contract \ Application
LIC282.pdf - Insurance
Liability Affidavit
LIC627.pdf – Consent for
Emergency Medical Treatment
LIC700.pdf – Identification
and Emergency Information
LIC9150.pdf – Additional
Children in Care
LIC995A.pdf – Notification
of Parents Rights
LIC995E.pdf – Caregiver
Background Check Process
PUB72.pdf – Health and Safety
Checklist
Provider Forms
LIC9040.pdf – Child Care
Facility Roster
LIC9058.pdf – Applicant /
Licensee Rights
LIC9148.pdf – Earthquake
Preparedness Checklist
LIC610A.pdf – Emergency
Disaster Plan For Family Child Care Homes
LIC624B.pdf – Unusual
Incident / Injury Report – Family Child Care Home