Licensing/Relicensing Forms

Required Forms

Licensing Requirements Checklist (relicensing form)

Floor and Escape Plan

Alcohol and Drug Use Policy

Grievance Procedure

Sample

Sample

Emergency Preparedness Plan

Worker’s Compensation

Emergency Phone Numbers

Addendum to Emergency Preparedness Plan

Sample

Enrollment Form

Licensing Actions

FCC Request for Expedited Correction Order Reconsideration

Licensing Requirement Dispute Form

Enrollment Forms

Admissions & Arrangements

Mandated Reporter Policy

Liability Insurance Notice

Child Care Immunization Form

Allergy Information Form

Perscription & Non-Perscription Medication Adminstration

Sample

Travel & Activity Authorization

Sample

Infant Specific Forms

Physician Directive for Alternative Sleep Position

Infant under 6 Months Rolling Over

Swaddling Consent

General Forms

Crib Inspection

Storm & Fire Drill Log

Sample

Serious Injury Form/Accident Report

Sample

Substitute Tracking Hours

Sample

Swimming/wading pool

Wading Pool Risks

Wading Pool Permission Form

Swimming Pool Risks

Swimming Pool Permission

Training Forms/information

Pre-Licensing Training

Ongoing Training for License Holder & Adult Caregiver

SUIDS/AHT Video Verification

Sample

Pre-Service Training - Substitute/Helper

Ongoing Training - Substitute & Helper

Capicity Worksheet

See DHS webpage for any additional info or updates

Department of Human Services Licensing