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Child Care Provider Registration Agreement Page 11 v. A child under the age of 13 with a diagnosis by a licensed physician, certified psychologist or a certified behavioral health specialist with a physical, cognitive and/or a psychosocial condition that substantially limits the child’s ability to perform age-appropriate activities. vi. Others, as approved by ADES. c. No more than 10% of a “group” can be children with disabilities. (See Section 3.7, Provider’s Responsibilities to Clients, 12., for the definition of Group Size.) 3.8 RECORD KEEPING REQUIREMENTS 1. Sign-In/Sign-Out Record format a. You agree to use either the Sign-In/Sign-Out Record form (CC-218) provided by ADES [see Attachment #11]; or, 1. With ADES approval you may design a substitute record. A substitute record shall be legible when copied and measure 8-1/2” x 11.” 2. An alternative method of daily attendance verification, such as an ADES approved, computerized tracking system, bio-metric or digital fingerprint recognition system. The alternative method requires written pre-approval by ADES prior to implementation. Records maintained in an approved alternative format shall be signed in ink on a weekly basis by the Client, or an individual identified on the Emergency Card. Time clocks and time cards shall not be permitted as an alternative method; b. All methods of daily attendance verification record shall include the following statements: 1. PENALTY WARNING: By signing this document the parent, guardian, or other authorized person verifies, under penalty of perjury, that the times recorded are the actual times the child was in attendance; and, 2. PENALTY WARNING: The submission of billing claim forms for the child named on this record constitutes verification by the Provider, under penalty of perjury, that this document is a true and accurate record of signatures, dates, and time of service; c. You agree to maintain original sign-in/sign-out records in accordance with the following requirements: 1. You agree not to directly or indirectly identify a child receiving ADES subsidies; 2. A separate sign-in/sign-out record shall be completed for each child in care. Each record shall contain your business name, name of the child, Client’s name, and the month and year in which care was provided; 3. All time entries, including corrections, on the sign-in/sign-out record shall be legible and in ink (unless approved to utilize an alternative method of daily attendance verification); 4. Signature entries shall be in ink and be the legal signature of the person completing the entry; 5. The sign-in/sign-out record shall indicate accurate dates and the precise times (including hour and minutes) a child is in your care; 6. Time entries are to be completed at the time the child arrives or leaves the facility and only by the person who signs the child in or out of the facility; 7. If you are open for more than 12 hours, the sign-in/sign-out record shall specify a.m. or p.m., or the use of military time, for each time entry; CCA-1210B (4-16) – Arizona Department of Economic Security