PROVIDER FORMS
CHILD Enrollment Forms
- Admission and Arrangements – required for each child in care
- Allergy Information - required for any child with allergies
- Immunization Record – required for each child in care
- Infant Rolling Over if under 6 months
- Liability Insurance Notification to Parents/Guardians – required any time insurance renews, lapses, or changes
- Permission to Administer - required for each child in care prior to administering, (optional DHS Form, if preferred)
- Physicians Directive for Infant Sleep Position
- Swaddling Permission
- Swimming Pool Risks
- Swimming Pool Permission
- Travel and Activity Authorization - may be used to authorize permission for the provider to transport children in a vehicle, use public transportation or participate in an activity away from childcare setting
- Wading Pool Risks
- Wading Pool Permission
PROVIDER Forms
- Application
- Special Child Care Primary Provider of Care - Complete to identify a primary provider of care for your Special Family Child Care Program. This form should be returned to your county licensor upon completion.
- Licensing Requirements - A guide to assist you with the development of policies and procedures required to operate a licensed family child care program. This is also the relicensing checklist that is completed at relicensing with the Application form.
- Background Study Data Collection Form
- Physician’s Report – required at initial licensing for license holders, and before any other caregiver works more than 30 days in a year
- Substitute Tracking Hours
- Alcohol & Drug Use Policy – license holder is required to have a policy and train all employees
- Grievance Policy - license holder is required to have a policy to train all employees
- Floor and Escape Plan
- Emergency Preparedness Plan - required to be updated annually
- Mandated Reporting Form - As of Sept. 30, 2019 you must give this document to parents of children who enroll in your program. Parents can acknowledge receipt of this document by using the checkbox on the Admission and Arrangements form. You are not required to distribute this document to currently enrolled families, but you must make them available upon request.
- Serious Injury Reporting Form - please email completed form
- Workers Compensation
- Monthly/Annual Crib Inspection Form
- Monthly Fire and Storm Drill Log
- Enrollment Form
This not a complete list of DHS forms used in child care, please visit the DHS website if you are not seeing the form you need.
- Family Child Care Variance Policy
- Variance Request Family Child Care – DHS 7297
- Family Child Care Weekly Attendance – DHS 7297A
- Variance Request for Parents – DHS 7297B
BACKGROUND STUDIES
DHS is implementing enhanced background studies for family child care providers.
• Who needs a Background Study Worksheet
• Acceptable Forms of Identification for DHS Fingerprinting
• Background Study Privacy Notice
• Background Study Process & Flow Chart
• Background Study Data Collection Form
Visit the DHS website, and go under the “Background studies” heading for further information and guidance.
TRAINING Provider Information
• Training Requirements for License Family Child Care - This 4-page fact sheet answers questions providers may have, including requirements for different roles, initial training requirements ongoing training requirements, definition of "annual", training not required annually, and resources
• DHS website - under the heading “Training” offers details on training requirements, along with definitions/roles within a licensed family child care
• The “Employment Tracking & Training for Family Child Care” logs below, while not required, are very helpful to use for license holders, as well as others working at the family child care site.
Initial Employment Tracking & Training
Ongoing” Employment Tracking & Training
• Pediatric CPR/First Aid Training - can be found on the Develop website or may be found locally through hospitals or community education departments
• SUID/AHTSUID/AHT videos are required to be viewed on the year the training is not completed. These videos can be found on the DHS website under “TRAINING,” then “Training requirements for licensed family child care programs.”
Once viewed, click here for the Training Verification document to provide to your licensor.
• Develop website for provider trainings as well as for child passenger restraint training.
• Child Care Aware
RESOURCES
- Child Care Aware
- Child/Adult Ratios; Age Distribution Restrictions
- Infectious Disease in Child Care
- Keeping Kids Safe – Child Care Provider Emergency Planning Guide
- US Consumer Production Safety Commission Recall List
- Rules and Regulations
Family Child Care is governed by many Minnesota Statutes and Rules. These may be found on the Office of Revisor of Statues website. Family Child Care Rule 9502 Human Services Licensing Act Human Services Background Studies