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

• Notification of Change
• Hogar de Cuidado de Niños Notificación de Cambio
• Change of Address Application (required when a provider changes the address for which a license was issued)
• Solicitud de cambio de dirección (requerido cuando un proveedor cambia la dirección para la cual se emitió una licencia)

Inspections

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

Child enrollment forms

• Child Enrollment Packet
• Paquete de Inscripción Infantil
• Child Enrollment Form
• Formulario de inscripción del niño
• Written Permission Form
• Formulario de permiso por escrito
• Early Childhood Health Assessment Record (Birth to Age 5)
• Immunization Requirements Schedule
• Medical Exemption Certificate
• Health Assessment Record (School Age)
• Incident Log
• Registro de incidentes
• Emergency Phone Numbers
• Numeros de Emergencia
• Sample forms
  • Child Records Checklist (Sample)
  • Lista de verificación de registros de niños (muestra)

Record keeping

• Child Developmental Milestones
• Metas Del Desarrollo Infantil
• Sample forms
  • Household Member Records Checklist (Sample)
  • Lista de verificación de registros de miembros del hogar (muestra)
  • Emergency Plan (Sample)
  • Sleep Arrangements for Infants (Sample)
  • Disposiciones para dormir a los infantes. ( Ejemplo)

First aid, CPR and medication administration

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

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

• Technical Assistance Request Form
• Early Childhood Consultation Partnership (ECCP)
• Capacity Explanation
• Explicación de capacidad
• Complying with the ADA
• Checklist for Maintaining Regulatory Compliance
• Su Lista de Verificacion Para Mantener Cumplimiento Regulatorio
• Guidance to Licensed FCCH Providers-Use of Approved Substitutes
• Uso de un Sustituto Aprobado en Ausencia del Proveedor
• CT Staffed Family Child Care Networks

Health and safety resources

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

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