Who is authorized to complete this form?

Parents or legal guardians typically complete the registry. Authorized custodial adults, delegated caregivers, or designated agency representatives may complete entries if supported by written consent or legal documentation verifying custody or guardianship.

Can this be signed electronically?

Yes. Electronic signatures are accepted where allowed by law if the record meets ESIGN Act and UETA standards: demonstrable intent, consent, clear attribution, and reliable retention. For sensitive consumer transactions, provide required disclosures under 15 U.S.C. §7001.

What supporting documents are needed?

Attach proof of identity for the child and signers, custody or guardianship orders if applicable, immunization records when requested, and physician statements for medical conditions or medication administration. Check recipient requirements for institution-specific attachments.

Are notarization or witnesses required?

Most routine child registry forms do not require notarization or witnesses. Exceptions exist for legal custody declarations or parental consents that function as affidavits; those documents may require a notary or specific witness counts per state law.

How is the child's data protected?

Treat registry records as confidential. Limit access to authorized personnel, use secure storage with encryption, and follow HIPAA where medical data is involved. Organizations should have written privacy policies and retention schedules to meet regulatory and institutional obligations.

How do I update or revoke entries?

Submit a revised registry form signed by the authorized party or provide written notice of revocation. Retain copies of both the original and the update. Agencies may require in-person verification or additional documentation for custody changes.

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California Child Registry

California Child Registry

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Child Support Case Registry Form (FL-191)

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)

FOR COURT USE ONLY

STAMP DATE RECEIVED HERE

DO NOT FILE

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

Mother

Father

First form completed

Change to previous information

CASE NUMBER

THIS FORM WILL NOT BE FILED IN THE COURT FILE. IT WILL BE MAINTAINED IN A CONFIDENTIAL FILE WITH THE STATE OF CALIFORNIA.

Notice: Pages 1 and 2 of this form must be completed and delivered to the court along with the court order for support.

1. Support order information

a. Date order filed:

b. Initial child support or family support order Modification

c. Total monthly base current child or family support amount ordered:

(1) Child support: ordered Reserved order $0 (zero) order Past due child support:

(2) Family support: ordered Reserved order $0 (zero) order Past due family support:

(3) Spousal support: ordered Reserved order $0 (zero) order Past due spousal support:

(4) Wage withholding ordered ordered but stayed until

2. Person required to pay child or family support (name):

Relationship to child:

3. Person or agency to receive child or family support payments (name):

Relationship to child (if applicable):

4. The child support order is for the following children:

Additional children are listed on a page attached to this document.

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

CASE NUMBER

You are required to complete the following information about yourself. You are not required to provide information about the other person, but you are encouraged to provide as much as you can.

5. Father's name:

a. Date of birth:

b. Social security number:

c. Street address:

City, state, zip code:

d. Mailing address:

City, state, zip code:

e. Driver's license number:

State:

f. Telephone number:

g. Employed Not employed Self-employed

Employer's name:

Street address:

City, state, zip code:

Telephone number:

6. Mother's name:

a. Date of birth:

b. Social security number:

c. Street address:

City, state, zip code:

d. Mailing address:

City, state, zip code:

e. Driver's license number:

State:

f. Telephone number:

g. Employed Not employed Self-employed

Employer's name:

Street address:

City, state, zip code:

Telephone number:

7. A restraining order, protective order, or nondisclosure order due to domestic violence is in effect.

a. The order protects: Father Mother Children

b. From: Father Mother

c. The restraining order expires (date):

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

Signature of person completing this form

Information Sheet for Child Support Case Registry Form

(Do NOT deliver this Information Sheet to the court clerk.)

Please follow these instructions to complete the Child Support Case Registry Form (form FL-191) if you do not have an attorney to represent you. Your attorney, if you have one, should complete this form.

Both parents must complete a Child Support Case Registry Form. The information on this form will be included in a national database, which, among other things, is used to locate absent parents.

If any of the information you provide on this form changes, you must complete a new form and deliver it to the court clerk within 10 days of the change.

This form is confidential and will not be filed in the court file.

INSTRUCTIONS FOR COMPLETING THE CHILD SUPPORT CASE REGISTRY FORM (TYPE OR PRINT IN INK):

Front page, first box, top of form, left side: Print your name, address, telephone number, fax number, and e-mail address, if any, in this box.

Front page, second box, left side: Print the name of the county and the court's address in this box.

Front page, third box, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box.

Front page, fourth box, left side: Check the box indicating whether you are the mother or the father. Also check whether this is the first form completed or a change to previous information.

Front page, second box, right side: Print the court case number in this box.

1. a. Enter the date the court order was filed.

1. b. Check whether the court order is initial or a modification.

1. c. Enter the ordered support information and wage withholding details.

Information Sheet for Child Support Case Registry Form

Additional instructions continue on this page, explaining how to complete the parent information, employment details, restraining order information, and the declaration section.

Use the same names listed on the court order when entering petitioner/plaintiff, respondent/defendant, and other parent information.

If you are employed, include your employer's name, address, and telephone number. If there is a restraining order, check the applicable boxes and provide the expiration date.

You must type or print your name, fill in the date, and sign the form under penalty of perjury.

What the California Child Registry Is

The California Child Registry is a standardized record used to collect and store essential information about a child for use by schools, childcare providers, social services, and authorized agencies. Typical entries include identifying details, emergency contacts, medical and allergy notes, custody or guardianship status, and consent statements for care or release. The registry may be maintained at the local school district, county child welfare office, or by licensed care programs, and is intended to centralize critical data for safety and administration while documenting consent and authorization in a consistent format.

Why keeping an accurate registry matters

Completing a California Child Registry consolidates a child's essential records for quicker emergency response, clearer custody and consent documentation, and smoother interactions with schools or care providers. It reduces administrative delays and creates a retrievable record that supports compliance with institutional policies.

Who typically completes or requests the registry

Parents, guardians, schools, licensed childcare operators, and county child welfare staff commonly complete or request the California Child Registry form.

Parents and legal guardians — provide identifying, medical, and custody information for care and emergency use.
School administrators — use registry data for enrollment, emergency contact lists, and accommodation planning.
Healthcare providers and nurses — reference medical notes, allergies, immunization status, and consent to treatment.

Organizations should request consent before collecting sensitive health or custody data and follow privacy rules when storing or sharing registry records.

Real-world examples of registry use

Representative examples of how organizations use the California Child Registry in routine scenarios for enrollment and emergency response.

School Enrollment

A K–12 district collects registry entries at enrollment to consolidate emergency contacts, medical alerts, and guardianship details for each student.

Reduces classroom response time in emergencies.
Signed digital records allow the district to verify permissions for field trips and medical care quickly, reduce paper processing burdens, and maintain an audit trail for parental consent and compliance with district policies and state reporting requirements.

Healthcare Intake

A pediatric clinic uses the registry to capture allergies, medication authorizations, and emergency contacts before the first appointment, ensuring clinicians have verified consent and up-to-date medical details.

Speeds intake and reduces transcription errors.
When connected to a secure e-signature workflow and HIPAA-compliant storage, the registry reduces administrative follow-up, supports accurate billing and immunization tracking, and provides a retrievable record for emergency clinicians and licensure reviews.

Step-by-step: completing and submitting the registry

[INTRO] Follow this sequence to complete and submit the California Child Registry accurately and securely online.

01

Collect data: Gather child's legal name, DOB, address, and emergency contacts.
02

Add medical info: List allergies, medications, immunizations, physician contact, and special instructions.
03

Provide consent: Sign custody statements, release authorizations, and emergency treatment consents.
04

Submit and retain: Send to school or agency; keep a signed copy for records.

How online submission typically works

Typical online workflow for creating, signing, and storing a California Child Registry entry securely and electronically.

Upload: Upload completed registry PDF or form template.
Place Fields: Add signature, date, and conditional fields for consent.
Send to Signers: Email or link with authentication options for recipients.
Store & Audit: Save signed copy and preserve audit trail with metadata.

Technical considerations for digital submission

Digital submission and storage require compatible file formats, authentication, and integration with agency systems and processes.

Supported Formats: PDF, DOCX, and HTML accepted.
Integrations: Salesforce, Microsoft 365, NetSuite, Google Workspace.
Authentication: Email link, SMS code, or advanced 2FA.

Security and compliance features to consider

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest.

Audit Trail: Time stamps, IP, action history retained.

HIPAA: Compliant when BAA signed; protects PHI.

ESIGN/UETA: Meets intent, consent, attribution, retention tests.

Access Controls: Role-based access and multi-factor authentication supported.

Certifications: SOC 2 Type II, ISO 27001, PCI DSS certifications.

Key risks and consequences of incorrect records

Invalid Consent: Unsigned forms may be unenforceable.

Privacy Violation: HIPAA fines and civil liability.

Delayed Care: Missing medical info delays treatment.

Custody Disputes: Incorrect records complicate legal proceedings.

Data Breach: Unauthorized disclosure risks compliance penalties.

Tax/Reporting: Backup withholding or reporting errors.

Key timing considerations and triggers

Key timelines for submission, updates, and legal holds affecting registry entries and related records administration.

Initial submission upon enrollment or intake:

Provide registry at time of enrollment or first attendance.

Update record after any material change:

Submit updates within 30 days of name, address, or custody changes.

Conduct an annual review and confirmation:

Confirm details yearly or as required by receiving agency.

Retention after service ends or dispute:

Preserve records during any custody dispute or litigation hold.

Immediate access required in emergency situations:

Ensure authorized staff can retrieve records without delay.

eSignature vendor pricing and capability comparison

Vendor pricing and feature comparison for eSignature options commonly used to complete and exchange California Child Registry records.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial, no credit card required	Check vendor site for current trial terms	Check vendor site for current trial terms	Check vendor site for current trial terms	Check vendor site for current trial terms
Bulk Send	Yes — available on paid plans	Yes — available on paid plans	Yes — available on paid plans	Yes — available on paid plans	No on basic plans
Audit Trail	Yes — full audit trail	Yes — full audit trail	Yes — full audit trail	Yes — full audit trail	Yes — full audit trail
HIPAA Compliant	Yes (BAA available)	Yes (BAA available)	Yes (BAA available)	No	No

Practical tips to improve accuracy and compliance

Practical tips to reduce errors, protect privacy, and speed processing for California Child Registry submissions.

Verify signer identity and document accuracy

Confirm signer identity using government ID or secure e-authentication; cross-check name, birth date, and custody documentation. Accurate identity verification prevents disputes and supports admissibility if registry entries are used in legal or emergency contexts.

Limit data collection to necessary items

Collect only information required for care, emergency response, or legal consent. Avoid storing unrelated sensitive data. Minimizing data reduces privacy risk and simplifies compliance with data protection rules such as HIPAA when medical information is present.

Maintain a secure audit trail

Preserve timestamps, IP addresses, and action logs for every signature and amendment. A detailed audit trail supports e-signature legal validity under ESIGN and UETA and provides evidence in custody or regulatory reviews.

Coordinate with receiving agencies early

Confirm specific form versions, required attachments, notarization, witness, or retention requirements with the school, county office, or care provider before submission. Early coordination prevents rejections and ensures the registry meets institutional acceptance criteria.

Frequently asked questions about the California Child Registry

Common questions and solutions for preparing, submitting, and maintaining a California Child Registry record, including e-signature and privacy concerns.

Need help? Contact support

Who is authorized to complete this form?
Parents or legal guardians typically complete the registry. Authorized custodial adults, delegated caregivers, or designated agency representatives may complete entries if supported by written consent or legal documentation verifying custody or guardianship.
Can this be signed electronically?
Yes. Electronic signatures are accepted where allowed by law if the record meets ESIGN Act and UETA standards: demonstrable intent, consent, clear attribution, and reliable retention. For sensitive consumer transactions, provide required disclosures under 15 U.S.C. §7001.
What supporting documents are needed?
Attach proof of identity for the child and signers, custody or guardianship orders if applicable, immunization records when requested, and physician statements for medical conditions or medication administration. Check recipient requirements for institution-specific attachments.
Are notarization or witnesses required?
Most routine child registry forms do not require notarization or witnesses. Exceptions exist for legal custody declarations or parental consents that function as affidavits; those documents may require a notary or specific witness counts per state law.
How is the child's data protected?
Treat registry records as confidential. Limit access to authorized personnel, use secure storage with encryption, and follow HIPAA where medical data is involved. Organizations should have written privacy policies and retention schedules to meet regulatory and institutional obligations.
How do I update or revoke entries?
Submit a revised registry form signed by the authorized party or provide written notice of revocation. Retain copies of both the original and the update. Agencies may require in-person verification or additional documentation for custody changes.

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