Forms for licensed child care providers

Forms licensed child care centers must use to document required information:

• Applicant Agreement, Acknowledgement, and Verification Form. An original notarized copy of the Applicant Agreement, Acknowledgement, and Verification Form is required for each application.
• Emergency Plan. Each center must have a site-specific emergency plan using the required Child Care Emergency Plan DHS-7955 (PDF) (4/24).
• Maltreatment of Minors Mandated Reporting Policy. Centers are required to use the Maltreatment of Minors Mandated Reporting policy (DHS-7634A) (PDF) (10/24).
• Serious Injury and Death Reporting Form. Centers must use the required DHS fillable Child Care Center Serious Injury and Death Reporting Form (PDF) to report any serious injury or death of a child in care.

Optional forms licensed child care centers can use to document required information: 

• Child Care Center Medication Authorization DHS-8373 (1/24)
• Directive for Alternative Infant Sleep Position DHS-7216 (PDF) (1/24)
• Equipment and Supplies – Infant (PDF)
• Equipment and Supplies – Preschool (PDF)
• Equipment and Supplies – School Age (PDF)
• Equipment and Supplies – Toddler (PDF)
• Experienced Aide Report DHS-5271 (PDF) (1/18)
• Field Trip Authorization for Licensed Child Care Centers DHS-8414 (3/23)
• Health Care Summary (PDF) (1/01)
• Helmet Approval for Sleeping Infant DHS-8531 (PDF) (1/24)
• Individual Child Care Program Plan (ICCPP) DHS-7995 (PDF) (7/24)
• In-service Training Record (PDF) (11/20)
• Licensed Child Care Center Drill Log (10/22)
• Monthly Crib Safety Inspection (PDF) (8/13)
• Optional Form for Parent Statement: Infant Less Than Six Months of Age Regularly Rolling Over DHS-7219 (PDF) (1/24)
• Orientation Record (PDF) (3/22)
• Parent Cradleboard Request and Monthly Cradleboard Check Form DHS-8536 (PDF) (1/24)
• Personnel Information Form DHS-7994 (PDF) (9/23)
• Risk Reduction Plan (PDF) (07/24)
• Separation Report DHS-5862 (PDF) (07/21)
• Staffing Patterns Documentation DHS-7999 (PDF) (1/23)
• Summary of Personnel Information for Licensed Child Care Centers DHS-4681 (PDF) (5/22)
• Swaddling Consent for an Infant DHS-7218 (PDF) (1/24)
• Training Requirements for Licensed Child Care Centers (PDF) (12/19)
• Unqualified Substitute Report (PDF) (1/01)

Resource documents licensed child care centers can use: 

• Accepted College Courses to Qualify Classroom Staff DHS-7886A-ENG (PDF) (7/19)
• Checklist for Administrative Records for Licensed Childcare Centers DHS-8229 (PDF) (3/24)
• Checklist for Children's Records for Licensed Childcare Centers DHS-8227 (PDF) (3/24)
• Checklist for Personnel Records for Licensed Childcare Centers DHS-8228 (PDF) (3/24)
• Child Care Centers Background Study Worksheet: Is a background study required? DHS-7733A (PDF)
• Guidelines for Developing Policies and Procedures DHS-4719 (PDF) (10/23)
• Licensing Checklist for Licensed Child Care Centers (Excel) (4/24)
• Supervision Fact Sheet for Licensed Child Care Centers (PDF) (7/24)
• Who or what are your controlling individuals? DHS-8000A (PDF) (1/20)