Family Child Care Homes – Forms and Documents

Become a licensed provider

• Initial License Application
• Adult Medical Statement
• Early Childhood Health Assessment Record (birth to age five)
• Health Assessment Record (school age)

Change or update your license

• Change of Address Application (English) (Spanish)
  • This form is required when a provider changes the address for which a license was issued.
• Notification of Change Form (English) (Spanish)

Inspection Forms

• Inspection Form (Sample)
• Corrective Action Plan and Resolving Disputed Violations (Spanish)
• Guide to the Child Care and Youth Camp Investigation Process

Children’s Records

• Child Enrollment Packet (English) (Spanish)
• Child Enrollment Form (English) (Spanish)
• Early Childhood Health Assessment Record (Birth to Age 5)
• Emergency Phone Numbers (English) (Spanish)
• Health Assessment Record (School Age)
• Immunization Requirements Schedule
• Incident Log (English) (Spanish)
• Medical Exemption Certificate
• Written Permission Form (English) (Spanish)
• Sample forms
  • Child Records Checklist (English) (Spanish)

Record keeping

• Child Developmental Milestones(English) (Spanish to be posted)
• Sample forms
  • Emergency Plan (Sample) (Spanish)
  • Household Member Records Checklist (English) (Spanish)
  • Sleep Arrangements for Infants (English) (Spanish)

First Aid, CPR and Medication Administration

• Authorization for Administration of Medication
• CPR Courses for Child Care
• Disposing of Prescription Meds and OTC Products
• First Aid Courses for Child Care
• Individual Plans of Care FAQs
• Parent Authorization for Administration of Non-Prescription Topical Medications (Spanish)
• Petition for Special Medication Authorization
• Sample Forms:
  • Written Approval for Administration of Medication Training Certificate
  • Individual Plan of Care(English)(Spanish)

Watch our Administration of Medications video for more information.

Mandated reporting

For information about Mandated Reporter Training, visit the CT Department of Children and Families (DCF).

• Reporting Suspected Child Abuse or Neglect (DCF-136)

Technical assistance and support

• Family Child Care Capacity Q & A (English) (Spanish)
• Checklist for Maintaining Regulatory Compliance (English) (Spanish)
• Complying with the ADA
• CT Staffed Family Child Care Networks
• Early Childhood Consultation Partnership (ECCP)
• Guidance to Licensed FCCH Providers-Use of Approved Substitutes (English) (Spanish)
• Technical Assistance Request Form

Health and safety resources

• Green Cleaning in Child Care Settings
• Hand Sanitizer Fact Sheet
• How to Request an Immunization Record From CIRTS
• Integrated Pest Management for Child Care Facilities
• Managing Asthma in Child Care Facilities
• MRSA Fact Sheet
• Nutrition Standards (English) (Spanish)
• Protecting Children and Staff on Hot Weather Days

For information and resources concerning congenital cytomegalovirus, lead, bed bugs, and other related topics, please visit the CT Department of Public Health (DPH).