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Certification Forms

Certified Family Child Care Application Forms:

Certification Application - Family In-Home Child Care Programs (DCF-F-DWSW48-E) - Word / PDF
W-9 Taxpayer Identification Number (TIN) Verification (DCF-F-149-E)
Background Information Disclosure (BID) Form
- Hmong: Lus Qhia au Txog Daim Ntawv Qhia Tawm Txog Keeb Kwm
- Spanish: Instrucciones para Divulgar Informacion de Antecedentes
Landlord Permission to Operate a Certified Child Care Business (DCF-F-DWSW13260-E)
(Needed if applicant is renting the home where the care will be given)
Regulatory Agency Approval/Acknowledgement to Operate Child Care Business
(Applicant holds another license/certificate to care for children or adults. Example: foster parent or child care license)
Standards and Checklist – Family / In-Home Child Care Certification (DCF-F-DWSW49-E)
- NORMAS Y LISTA DE CONTROL – CERTIFICACIÓN DE SERVICIOS FAMILIARES Y EN EL HOGAR DE CUIDADO DE NIÑOS (Spanish)
- COV CAI ZOV MENYUAM THIAB DAIM NTAWV TEEM COV NQE LUS – DAIM NTAWV TSO CAI ZOV MENYUAM HAUV TSEV (Hmong)

Certified Provider Forms:

Authorization to Administer Medication - Child Care Centers (DCF-F-CFS0059)
Child Health Report - Child Care Centers (DCF-F-CFS0060)
(required for children who are not enrolled in school)
- Hmong: QHIA PAUB TXOG ME NYUAM KEV NOJ QAB HAUS HUV – COV CHAW ZOV ME NYUAM
Daily Attendance Record - Certified Child Care (DCF-F-62-E) - Word / PDF

Day Care Immunization Record
(required for all children in care)

Spanish: Registro de Inmunizaciones para Guardería Infantil

Child Enrollment and Health History - Certified Child Care (DCF-F-DWSW13251-E) - Word / PDF
Intake for Child Under 2 Years - Child Care Centers (DCF-F-CFS0061)
Parent Checklist - Certified Family Child Care Providers (DCF-F-DWSW50)
Written Policies
- Sample
- Electronic form to fill out

School-Age Certification Forms:

Certification Application - School-Age Care Centers (DCF-F-DES12200-E) - Word / PDF
Standards and Checklist (DCF-F-DES12203)
Compliance Statement - Certified School-Age Child Care (DCF-F-2664-E)

Caregiver Law Related Forms

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Ordering Paper Copies

Paper copies of most certification forms can be ordered from DOA. You can find the ordering instructions here.

Licensed Child Care Provider Forms

Updated January 03, 2012

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