Receipt of the Summary of the TN Licensing Requirements Form

Receipt of the Summary of the TN Licensing Requirements Form
I have read the document entitled TN Department of Human Services Summary of Licensing Requirements for Child Care Agencies.
Child's Name

First NameLast Name
Parent's Name

First NameLast Name
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: