Wisconsin Department of Children and Families

Protecting Children, Strengthening Families, Building Communities

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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:

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 10/19  English Word Certification Application - Family/In-Home Child Care Programs
DCF-F-DWSW48 10/19  English PDF Certification Application - Family/In-Home Child Care Programs
DCF-F-DWSW48-S 09/18 Spanish PDF Solicitud de Certificación para Brindar Cuidado Infantil Diurno Residencial y Familiar
DOA-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 10/19 English PDF Standards and Checklist – Family / In-Home Child Care Certification
DCF-F-DWSW49-S 02/18 Spanish PDF Normas y Lista de Verificación – Certificación de Cuidado Infantil Familiar / en la Casa
DCF-F-5109 09/17 English PDF YoungStar Contract - Family Provider
DCF-F-5109-S 09/17 Spanish PDF Contrato de YoungStar – Proveedor familiar
DCF-F-5109-H 09/17 Hmong PDF YoungStar Daim Ntawv Cog Lus – Zov Me Nyuam Hauv Tsev
DCF-F-5331-E 08/19 English Word Petition for Appeal of Ineligibility Determination
DCF-F-2587 06/18 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 06/18 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.
DCF-F-2587-H 06/18 Hmong

Word

Wisconsin Shares Qhov Kev Koom Daim Ntawv Cog Lus
(Wisconsin Shares Participation Contract)
Cov neeg ua ntawv thov kev pab zov me nyuam hauv tsev (cov uas zov cov me nyuam hauv tus me nyuam tsev) uas yuav zov cov me nyuam tau nyiaj pab them los ntawm Wisconsin Shares yuav tsum muaj daim ntawv no.

 

 

Certified Operator Forms and Publications
Number Date Translation Type Title
DCF-P-2436 10/19 English PDF  Your Guide to Regulated Child Care - Summary of the Child Care Rules
DCF-P-2436-S 07/17 Spanish PDF Su Guia Para el Cuidado Infantil Regulado - Su resumen sobre las normas del cuidado infantil
DCF-F-CFS0059-E 10/19 English Word Authorization to Administer Medication - Child Care Centers
DCF-F-CFS0059 10/19 English PDF Authorization to Administer Medication - Child Care Centers
DCF-F-CFS0059-S 08/10 Spanish PDF Autorizacion para Administrar Medicamentos – Centros de Cuidado de Ninos
DCF-F-CFS0060 10/19 English PDF Child Health Report - Child Care Centers
DCF-F-CFS0060-E 10/19 English Word Child Health Report - Child Care Centers
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 05/16 Spanish PDF Registro diario de asistencia – Programa certificado de cuidado infantil
F-44192 09/08 English PDF Child Care Immunization Record (required for all children in care)
F-44192S 09/08 Spanish PDF Registro de Inmunizaciones para Guardería Infantil
DCF-F-DWSW13251-E 01/15 English Word Child Enrollment and Health History - Certified Child Care
DCF-F-DWSW13251-E 01/15 English PDF Child Enrollment and Health History - Certified Child Care
DCF-F-DWSW13251-S 01/15 Spanish PDF Inscripción de Niños e Historial de Salud – Guardería Certificada
DCF-F-CFS0055-E 10/19 English Word Incident Report - Regulated Child Care Centers
DCF-F-CFS0055 10/19 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 01/09 Spanish PDF Admision Para Ninos menores de 2 Anos - Guarderias
DCF-F-DWSW50 07/16 English PDF Parent Checklist - Certified Family Child Care Providers
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
Written Policies 08/12 English Word Written Policies: Worded for licensed providers, but the Word-fillable version can be modified to apply to certified providers.
Written Policies 08/12 English PDF Written Policies: Worded for licensed providers but the Word-fillable version can be modified to apply to certified providers.
DCF-F-242-E 05/12 English Word Child Record Checklist Certified Child Care
DCF-F-242 05/12 English PDF Child Record Checklist Certified Child Care
DCF-F-DES12200-E 12/13 English Word Certification Application - School-Age Care Centers
DCF-F-DES12200 12/13 English PDF Certification Application - School-Age Care Centers
DCF-F-DES12203 08/16 English PDF Standards and Checklist
DCF-F-CFS2344 12/12 English PDF Building Inspection Report
DCF-F-5109 09/16 English PDF YoungStar Contract - School-Age Programs
0-NA 08/12 English Word Policy Sample - Family Child Care Centers
0-NA 08/12 English PDF Policy Sample - Family Child Care Centers
DCF-P-5202 10/19 English PDF DCF Approved Agencies Offering Non-Credit Courses
DCF-P-5206 08/19 English PDF Barred Offenses (Crimes Table) - Regulated Child Care
DCF-F-0053A 05/16 English PDF Staff Continuing Education Record - Regulated Child Care Centers
DCF-F-2114 04/13 English PDF Continuing Education Record - Independent Reading/Video Viewing
DCF-F-5224 12/17 English Word Provider/Parent Payment Agreement
DCF-F-5224H 12/17 Hmong Word Kws Zov Me Nyuam/Niam Txiv Kev Pom Zoo Rau Tus Nqi Them
DCF-F-5224S 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