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
- Permission to Administer - required for each child in care prior to administering, (optional DHS Form, if preferred)
- Liability Insurance Notification to Parents/Guardians – required any time insurance renews, lapses, or changes
- Swaddling Permission
- Infant Rolling Over if under 6 months
- Physicians Directive for Infant Sleep Position
- 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
- Swimming Pool Risks
- Swimming Pool Permission
PROVIDER Forms
- Enrollment Form - have completed and ready for licensor at your off-year or relicensing visit
- Monthly/Annual Crib Inspection Form
- Monthly Fire and Storm Drill Log
- Floor and Escape Plan
- Workers Compensation
- Emergency Preparedness Plan - required to be updated annually
- Emergency Preparedness Plan Addendum - This document is required to complete if you have used the former Child Care Emergency Plan form dated 10/17 or prior. You will add this to your existing plan document. If you have completed the new Emergency Preparedness Plan 7414C, you will not be required to also complete this addendum.
- Serious Injury Reporting Form - please email completed form
- Mandated Reporting Form
- Application
- Background Study Data Collection Form
- 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.
- Physician’s Report – required at initial licensing for license holders, and before any other caregiver works more than 30 days in a year
- Chemical Usage Policy – license holder is required to have a policy and train all employees
- Substitute Tracking Hours
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.
COUNTY Specific Variance Forms
RESOURCES
- 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
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 Background Studies
• Background Study Privacy Notice
• Background Study Data Collection Form
• Kanabec County Background Study Process
• FAQ on Background Study Process
Visit the DHS website, and go under the “Background studies” heading for further information and guidance.
TRAINING Provider Information
• Training Requirements for Licensed FCC Providers
• Training log worksheet for tracking trainings. This is not required to use but may be a helpful tool for tracking.
• DHS Site, under “Training” Subheading
• Develop Site for provider trainings as well as for child passenger restraint training.
• CPR/1st Aid Trainings may be found locally through hospitals or community education departments.
• SUID/AHT videos are required to be viewed on the year that training is not completed. Click here for Training Verification Form.