Forms and Resources for Family Child Care Homes

Commonly used forms

Child enrollment

Child Enrollment Packet (English)
(Spanish)
Packet of forms for enrolling a child that contains:
* Child Enrollment Form
* Written Permission Form
* Early Childhood Health Assessment Record (birth to age 5)
* Immunization Record
* Child Care Incident Log
* Emergency numbers
Child Enrollment Form (English) 
(Spanish)
Parents fill this out to provide information about their child
Written Permission FormAllows parents to give permission for their child to participate in specific activities

Health and medical

Health assessments

TitleDescription
Early Childhood Health Assessment Record (birth to age five)Required health form for parents and a young child’s health care provider
Health Assessment Record (school age)Required health form for parents and a school-age child’s health care provider

Medication

TitleDescription
Authorization for Administration of Medication (English)
(Spanish)
Required health form for parents and the child’s health care provider that allows staff to give medication
Authorization for Administration of Non-Prescription Topical Medications (English)
(Spanish)
Authorizes staff to administer non-prescription topical medications to a child
Medication Administration Record SampleExample of a chart you can use to keep track of medication
Medication Administration Policy Sample (English)
(Spanish)
Sample policy you can adapt for how you provide medication to students
Petition for Special Medication AuthorizationChecklist of steps and permissions needed for a child care facility to get authorization to give medication
Written Approval for Administration of Medication Training Certificate SampleExample of a certificate you can adapt to show staff is trained to give medication in childcare settings

Immunizations

TitleDescription
Immunization Requirements ScheduleTable showing required shots for different ages of children in child care programs
Medical Exemption for Required ImmunizationsIf a parent wants a child to be exempt from vaccinations, they and the child’s health care provider need to fill out this form

First Aid and CPR

TitleDescription
First Aid & CPR Courses for Child Care
(Spanish)

UPDATE — LINKS ARE BROKEN ON CT.GOV
List of available courses

Program licensing and operations

TitleDescription
Notify Licensing About Changes to Your Program (online form)Required for any changes you make to your program that that differ from what’s stated in your license or application
Request technical assistance Get help maintaining compliance and meeting licensing requirements
Report of Suspected Child Abuse or Neglect (DCF-136)Form and instructions for mandated reporters to submit written reports

Inspections and compliance

TitleDescription
Checklist for Maintaining Regulatory Compliance (English) 
(Spanish)
Checklist of essential requirements for family child care providers, including staff qualifications, safety standards, provider responsibilities, and medication administration guidelines
Corrective Action Plan and Resolving Disputed Violations (English) 
(Spanish)
If OEC finds a violation during an inspection, use this form to document how you plan to fix it
Guide to the Child Care and Youth Camp Investigation ProcessOverview of how the complaint and investigation process works
Inspection Form SampleAn example of the form OEC will fill out when inspecting your program

Watch in Spanish

Records and documentation

TitleDescription
Child Care Incident Log (English) 
(Spanish)
Keep records of accidents, observations, injuries, illnesses, unusual behaviors
Child Records Checklist Sample (English) 
(Spanish)
An example of a form you can use to keep track of required child records and permissions
Emergency Phone Numbers (English) 
(Spanish)
Record of emergency contacts for each of your children to keep as a record
Household Member Records Checklist Sample (English) 
(Spanish)
Sample checklist you can adapt that outlines the required records for providers, staff, and household members
Individual Plan of Care Sample (English)
(Spanish)
Sample form you can adapt for creating an individual plan of care for a child with special health needs or disabilities
Individual Plans of Care FAQsQuestions and answers about the purpose, requirements, and implementation of individual plans of care for children with special needs or disabilities

Becoming a provider

TitleDescription
Initial license application packetPacket of forms for people seeking a license that contains:
Coordinating Check List
* Initial Application Fee Form
* Initial Application for Licensure
* Foster Care or Adoption Verification Form
* Adult Medical Statement for Child Care
* CT Early Childhood Health Assessment Record (for * children ages birth to 5)
* Health Assessment Record (for school age children)
* References
* Lead Water Test
Adult Medical StatementA form your doctor will fill out before you can get licensed.

Watch in Spanish (Cómo convertirse en un proveedore de cuidado de niños en el hogar con licencia)

Explore related pages

  • Health and Safety: Find resources about ventilation, disease control, mandated reporting, and more.
  • Helpful links: Quickly access key resources and essential information with our curated links for child care providers.
Last updated May 24, 2024