Required Forms

• Annual Declaration for Licensed Facility
• Request for Revision
• Application for License to Operate a Child Care Facility
• Center Director/Group Child Care Home Provider Approval Request
• Center Director/Group Child Care Home Provider Certification Request
• Notice of Parental Responsibility
• Overlap Request
• TB Risk Assessment Form

Sample Forms

The following are sample forms. These forms are not required to be submitted to the Office of Childhood; however, they are required to be kept on file at the facility.

• Accident/Injury Report
• Child Care Emergency Plan Template
• Child Care Enrollment Form
• Child Care Enrollment Form (Spanish)
• Child Care Work Experience
• Child Care Enrollment For License-Exempt Facilities
• Child Care Enrollment For License-Exempt Facilities (Spanish)
• Emergency School Closing Overlap Record
• Equipment List
• Fire/Tornado Drill
• Individual Plan for Specialized Care
• Infant and Toddler Feeding and Care Plan
• Listing of Child Care Staff Member(s)/ Household Member(s)
• Medical Examination Report for Caregivers & Staff
• Medical Examination Report for Infant/Toddler/Pre-school
• Medication Authorization
• New Employee Orientation Checklist
• Permission for Child to Leave Facility
• Safety Plan
• School-Age Child Health Report
• Variance Request
• Weekly Menu