Family Child Care Homes Forms and Documents

We’re here to help! If you have questions or want to file a complaint, don’t hesitate to call us at (860) 500-4450 or (800) 282-6063.

Become a licensed provider

• Initial License Application
• Approved First Aid Courses for Child Care
• 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 (required when a provider changes the address for which a license was issued)

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 and Emergency Medical Care Form
• Early Childhood Health Assessment Record (Birth to Age 5)
• Immunization Requirements Schedule
• Health Assessment Record (School Age)
• Emergency Phone Numbers
• Numeros de Emergencia
• Sample forms
  • Religious Exemption Statement (Sample)
  • Child Records Checklist (Sample)

Record keeping

• Child Developmental Milestones
• Metas Del Desarrollo Infantil
• Sample forms
  • Household Member Records Checklist (Sample)

First Aid 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
• Approved First Aid Courses for Child Care

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)
• Complying with the ADA
• Checklist for Maintaining Regulatory Compliance
• Su Lista de Verificacion Para Mantener Cumplimiento Regulatorio

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
• Disposing of Prescription Meds and OTC Products
• 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).