Child Care Certification Forms and Publications There are a number of useful application forms and other documents for certified child care providers. Use the two searchable tables below to locate Certified Family Child Care Application Forms and Certified Operator Forms. If you have questions about any of these forms, please contact your local agency certifier. Other forms, publications that may be of interest include: Rehabilitation Review Information and Application Licensed Child Care Provider Forms Some of our forms and publications are preprinted and can be ordered directly from Document Sales. Certified Family Child Care Application Forms Number Date Translation Type Title DCF-F-5296-E 10/19 English Word Background Check Request DCF-F-5296-H 10/19 Hmong PDF Keeb Kwm Dhau Los Txheeb Xyuas Cov Lus Thov DCF-F-5296-S 10/19 Spanish PDF Solicitud de Verificacion de Antecedentes DCF-F-DWSW48-E 12/23 English Word Certification Application - Family/In-Home Child Care Programs DCF-F-DWSW48 12/23 English PDF Certification Application - Family/In-Home Child Care Programs IRS-W9 11/17 English PDF W-9 Request for Taxpayer Identification Number (TIN) and Certification Instructions to complete the W-9 Form DCF-F-DWSW13259-E 10/19 English Word 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.) DCF-F-DWSW13259 10/19 English PDF 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.) DCF-F-DWSW49 10/21 English PDF Standards and Checklist – Family / In-Home Child Care Certification DCF-F-DWSW49-S 10/21 Spanish PDF Normas y Lista de Verificación – Certificación de Cuidado Infantil Familiar / en la Casa DCF-F-5109 07/19 English Word YoungStar Contract - Family Provider DCF-F-5109-S 07/19 Spanish Word Contrato con YoungStar DCF-F-5331-E 08/19 English Word Petition for Appeal of Ineligibility Determination DCF-F-2587 08/21 English Word Wisconsin Shares Participation Contract Required for In-home (providers caring for children in the child's home) applicants who will be caring for Wisconsin Shares funded children. DCF-F-2587-S 08/21 Spanish Word Contrato de participación en Wisconsin Shares (Wisconsin Shares Participation Contract) Obligatorio para solicitantes que cuidan a niños en la casa (proveedores que cuidan a niños en la casa del niño) que cuidarán a niños financiados por Wisconsin Shares. DHS-F-02314 10/19 English PDF Wisconsin Tuberculosis Risk Assessment and Symptom Evaluation English PDF Family Day Care Homes - Milwaukee Requirements & Analysis Form (For family child care in the City of Milwaukee) English PDF Occupancy Permit - City of Racine (For family child care in the City of Racine) Certified Operator Forms and Publications Number Date Translation Type Title 0-N/A 09/24 English Word Policy Sample - Emergency Plan Regulated Child Care DCF-F-CFS0056 10/19 English PDF Transportation Permission - Child Care Centers DCF-F-CFS0056-E 10/19 English Word Transportation Permission - Child Care Centers DCF-F-CFS0056-S 10/19 Spanish PDF Permiso de Traslado - Centros de Cuidado Infantil DCF-F-CFS0058-E 09/21 English PDF Field Trip or Other Off Premises Activity Notification/Permission DCF-P-2436 10/19 English PDF Your Guide to Regulated Child Care - Summary of the Child Care Rules DCF-P-2436-S 10/19 Spanish PDF Su Guia Para el Cuidado Infantil Regulado - Su resumen de las reglas del cuidado infantil DCF-F-CFS0059-E 04/20 English Word Authorization to Administer Medication - Child Care Centers DCF-F-CFS0059 04/20 English PDF Authorization to Administer Medication - Child Care Centers DCF-F-CFS0059-S 04/20 Spanish PDF Autorizacion para Administrar Medicamentos – Centros de Cuidado de Ninos DCF-F-CFS0060-E 09/21 English PDF Child Health Report - Child Care Centers DCF-F-CFS0060-S 09/21 Spanish PDF Informe de Salud Infantil - Centros de Cuidado Infantil DCF-F-62-E 10/19 English Word Daily Attendance Record - Certified Child Care DCF-F-62 10/19 English PDF Daily Attendance Record - Certified Child Care DCF-F-62-S 10/19 Spanish PDF Registro de Asistencia Diaria – Cuidado Infantil Certificado F-44192 2/23 English PDF Child Care Immunization Record (required for all children in care) F-44192S 2/23 Spanish PDF Registro de Inmunizaciones para Guardería Infantil DCF-F-DWSW13251-E 12/19 English Word Child Enrollment and Health History - Certified Child Care DCF-F-DWSW13251 12/19 English PDF Child Enrollment and Health History - Certified Child Care DCF-F-DWSW13251-S 12/19 Spanish PDF Historial de Salud e Inscripción del Niño – Cuidado Infantil Certificado DCF-F-CFS0055-E 04/21 English Word Incident Report - Regulated Child Care Centers DCF-F-CFS0055 04/21 English PDF Incident Report - Regulated Child Care Centers DCF-F-CFS0061-E 10/19 English Word Intake for Child Under 2 Years - Child Care Centers DCF-F-CFS0061 10/19 English PDF Intake for Child Under 2 Years - Child Care Centers DCF-F-CFS0061-S 10/19 Spanish PDF Admisión Para Niños Menores que 2 Años en Centros de Cuidado Infantil DCF-F-CFS0053A-E 10/19 English Word Staff Continuing Education Record - Regulated Child Care Centers DCF-F-CFS0053A 10/19 English PDF Staff Continuing Education Record - Regulated Child Care Centers DCF-F-242-E 10/19 English Word Child Record Checklist Certified Child Care DCF-F-242 10/19 English PDF Child Record Checklist Certified Child Care 0-NA 06/20 English Word Policy Sample - Family Child Care Centers: Written policies worded for licensed providers, but the Word-fillable version can be modified to apply to certified providers. 0-NA 06/20 English PDF Policy Sample - Family Child Care Centers: Written policies worded for licensed providers, but the Word-fillable version can be modified to apply to certified providers. DCF-P-5206 10/19 English PDF Barred Offenses (Crimes Table) - Regulated Child Care DCF-F-0053A 10/19 English PDF Staff Continuing Education Record - Regulated Child Care Centers DCF-F-2114 10/19 English PDF Continuing Education Record - Independent Reading/Video Viewing DCF-F-5224 12/17 English Word Provider/Parent Written Payment Agreement DCF-F-5224-S 12/17 Spanish Word Acuerdo de Pago Entre Proveedores/Padres DCF-F-5296-E 10/19 English Word Background Check Request DCF-F-5296-H 10/19 Hmong PDF Keeb Kwm Dhau Los Txheeb Xyuas Cov Lus Thov DCF-F-5296-S 10/19 Spanish PDF Solicitud de Verificacion de Antecendentes DCF-F-5383-E 11/19 English Word Driver Training Checklist - Child Care Centers DCF-F-5383 11/19 English PDF Driver Training Checklist - Child Care Centers DCF-P-503S 10/19 Spanish PDF Cuidado Infantil: ¿es legal? DCF-P-503 10/19 English PDF Your Child Care - Is it Legal? DCF-F-0104 06/21 English PDF Alternate Arrival/Release Agreement - Child Care Centers DCF-F-5596 02/23 English Word Staff Orientation Checklist - Certified Family Child Care Centers
