Forms

The purpose of this section is to make the most current forms available with a single resource. Forms are used to collect information and remain in the handbook until the form is no longer necessary.

ES = Spanish version available.

Title
Form 1099, Operational Discipline and Guidance Policy
Form 1100, Daily Building and Grounds Checklist
Form 2550, Operational Policy on Infant Safe SleepES
Form 2551, Licensed and Registered Home: Caregivers, Assistants, Substitutes and Household Members Information Record
Form 2760, Controlling Person – Child Care RegulationES
Form 2819, Residential Child Care Regulation Governing Body/Administrator or Executive Director Designation
Form 2820, Educational Facility Request for Exemption from Child Care Regulation
Form 2832, Single Skills Program During School Year Request for Exemption from Child Care Licensing Regulation
Form 2833, Single Skill Program Request for Exemption from Child Care Regulation
Form 2837, Governmental Entity Request for Exemption from Child Care Regulation
Form 2838, Miscellaneous Program Request for Exemption from Child Care Regulation
Form 2839, Program of Limited Duration Request for Exemption from Child Care Regulation
Form 2841, Small Employer-Based Child Care or Temporary Shelter Child Care Facility Application
Form 2881, Plan of Operation for School-Age Summer Program or Before/After School Program
Form 2885, Children’s Products Certification
Form 2906, Child Placing Agency Internal Investigation Report
Form 2907, CCL Statement of Foster Parent and Child-Placing Agency Rights and Responsibilities
Form 2910, Application for a License or Certification to Operate a Child Day Care Facility
Form 2911, Child Care Licensing Governing Body/Director Designation
Form 2912, Pre-Employment Affidavit for Applicants for Employment at Certain Child Care OperationsES
Form 2919, Request for a Registration PermitES
Form 2935, Admission Information
Form 2937, Child Care Regulation Waiver/Variance Request
Form 2940, Request for an Administrative ReviewES
Form 2941, Child Care Operation Sign-in/Sign-out Log
Form 2947, Child Care Center Personnel Information Record
Form 2948, Plan of Operation for Licensed Center and Home Operations
Form 2954, Child Care Licensing Family Violence Calls DisclosureES
Form 2960, Application for a License to Operate a Residential Child Care Facility
Form 2961, Request to Accept Children from Law Enforcement
Form 2962, Verification of Liability Insurance
Form 2963, Admission of a Child from a Law Enforcement Officer
Form 2971, Child Care Regulation Request for Background CheckES
Form 2974, Request for Risk Evaluation Based on Past Criminal History or Central Registry Findings
Form 2982, Personal History Statement
Form 2985, Affidavit for Applicants for Employment with a Licensed Operation or Registered Child-Care HomeES
Form 2986, Listing Permit RequestES
Form 2997, Results of Public Hearing
Form 3004, Family Foster Home Fire Safety Evaluation Checklist
Form 3014, Administrator License – Renewal or Status Change
Form 3015, Application for a Child Care Administrator License or a Child-Placing Agency Administrator License
Form 3016, Administrator Licensing - Reference for an Applicant
Form 3017, Child Care Regulation Request for Background Checks for an Administrator's License
Form 3018, Administrator Licensing – Change in Contact Information
Form 3019, Infant Sleep Exception/Health Care Professional Recommendation
Form 4001, Renewal Application for Recognition of Day Care Administrator's Credential Program
Form 4003, Foster Family Home Capacity Exception
Form 4004, Residential Child Care Licensing Environment Health Checklist
Form 7239, Incident or Illness ReportES
Form 7240, Monthly Attendance Record
Form 7243, Emergency Telephone Numbers
Form 7255, Medication AuthorizationES
Form 7259, Personnel Records Evaluation – Child Care Centers
Form 7260, Children's Records Evaluation – Child Care Centers
Form 7261, Center Records Evaluation
Form 7263, Emergency Practices
Form 7270, Children's Records Evaluation – LCCH/RCCH
Form 7271, Personnel Records Evaluation LCCH/RCCH
Form 7277, Child Care Licensing Plan of Action