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Completion Instruction for CC-218 SIGN-IN/SIGN-OUT RECORD 1. A separate sign-in/sign-out record is required for each child in care, and for each calendar month. 2. Each record must contain the provider’s name, child’s name, parent/guardian’s name, and the month and year in which care is provided. 3. Parent, guardian or other person authorized in writing must sign each child in and out on each day that care is provided. 4. Provider may sign a child in and out only when accepting and releasing the child to or from school. 5. Pre-signing of this record is not allowed. 6. The date column refers to the calendar date. 7. All time entries must be legible and in ink. 8. Signature entries must be in ink and the legal signature of the person completing the entry. 9. The record shall indicate accurate dates and the precise times a child is in care. Approximate time is not allowed. 10. Provider must review this record daily to ensure that it is completed with accuracy. 11. If a provider is open for more than 12 hours, this record must specify “a.m.” or “p.m.” for each time entry. The use of military time is acceptable. 12. All corrections must be initialed. 13. The use of arrows to correct where a signature and/or time is supposed to go is not allowed. 14. The use of correction fluid or correction tape on the records is not allowed. 15. If requested, the provider must send the original records to DES Child Care Administration. 16. Copies of sign-in/sign-out records must be provided to DES enrolled parents upon request. 17. Sign-in/sign-out records must be kept for five (5) years after expiration of the Child Care Provider Registration Agreement. DES CERTIFIED HOME PROVIDERS A copy of the record for all children must be submitted to the assigned Certification Specialist by the 5th business day following the end of each month. Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact 602-542-4248; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. CC-218 (7-14) – Page 52 Arizona Department of Economic Security