Provider Forms
General Forms (No ECE Number)
- Authorization for Protective Services Record Checks
- 2018 Informal-Relative Checklist.pdf
- Child Care Provider Medical Report
- Disaster Planning Form – Center & Facility
- Disaster Planning Form – Home, Informal, Relative
- Disaster Planning Form – Home, Informal, Relative & In-Home
- Immunization Guidelines
- Needs Assessment and Letter of Intent to Operate a Child Care Center
- Recommended Child and Adolescent Immunization Schedule
- Request to Amend Application – 2022
- Technical Assistance Request Form
- Tiered Reimbursement
ECE Numbered Forms
- ECE-CC-0162B Change of Information Notification
- ECE-CC-1B New Employment Verification
- ECE-CC-3 Child Health Assessment
- ECE-CC-3B Statement of Good Health
- ECE-CC-7 Provider Information Form
- ECE-CC-8A PS Check
- ECE-CC-8B Statement of Criminal Record
- ECE-CC-10A Request for Payment Child Care Services
- ECE-CC-10E Emergency Info Form
- ECE-CC-10G Child Care Attendance Sheet
- ECE-CC-10J Pet Acknowledgement Form
- ECE-CC-10K Child Care and Responsible Pet Ownership
- ECE-CC-14 Letter of Intent and Needs Assessment
- ECE-CC-14 Letter of Intent and Needs Assessment (Final)
- ECE-CC-14A Facility Info Packet
- ECE-CC-15 Facility Application
- ECE-CC-22 Provider Training Record
- ECE-CC-23 Fire Escape Plan
- ECE-CC-25 Medication Permission Slips
- ECE-CC-26 Child Care Provider Incident Report Form
Emergency Preparedness
Statewide Child Care Emergency Plan
COVID-19 Testing Information for child care providers
CDC Guidelines, signature form and checklist for child care providers
- CDC Child Care Guidance
- Polices and Procedrues Checklist form
- Checklist- General Preparedness and Planning
- COVID-19 Outbreaks in Childcare Guidance
Family Child Care Homes
Child Care Centers and Child Care Facilities
Emergency Preparedness Resources
Family Child Care Homes
If you are interested in becoming a Registered Family Child Care Home, please read the Family Child Care Information packet and the Family Home Registration Requirements.
After reading these documents complete the Family Child Care Needs Assessment and Letter of Intent, and mail to the address included.
Family Child Care Homes
- Title 78, Legislative Rules, DHHR, Series 19, Family Child Care Home Registration Requirements
- Family Child Care Information Packet
- Disaster Planning Form Family Child Care
- Family Child Care Homes Initial and Renewal Application
- Safety Barrier Guidelines for Residential Pools
The forms below are available for you to download and print to use after you have been approved as a Family Child Care Home.
- Child Medical Information Form
- Emergency Information Form
- Medication Permission Form
- Child Care Request for Payment
- Child Care Attendance Sheet
- Provider Training Record
- Child Care Provider Incident Form
- Pet Acknowledgement Form
- Responsible Pet Ownership Form
Medical Forms for Family Child Care Providers
Family Child Care Medical Form
Family Child Care TB Screening Form
If you have any additional questions, the map below has the contact information for Family Child Care Regulatory Staff
