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Forms for Child Care
- Background Study Documentation Form (72000-113 8/10 PDF)
- Certificate of Compliance (MN Workers’ Compensation PDF)
- Child Care Assistance Provider Form (EA-572 6/15 PDF)
- Child Enrollment-Family Child Care (DHS-7934 PDF)
- Class A License Worksheet (72000-129 A 9/14 PDF)
- Class C-1 License Worksheet (72000-129 C-1 9/14 PDF)
- Class C-2 License Worksheet (72000-129 C-2 9/14 PDF)
- Class C-3 License Worksheet (72000-129 C-3 9/14 PDF)
- Data Collection Form-Background Study-CC (6/19 PDF)
- Electronic Data Consent (70000-21 9-20 PDF)
- Emergency Preparedness Plan (DHS-7414C PDF)
- Emergency Preparedness Plan Addendum (DHS-7955 PDF)
- Family Child Care Request for Expedited Correction Order Reconsideration (DHS-TCM-1053-327240 PDF)
- Family Child Care Weekly Attendance Schedule (DHS-7297A PDF)
- Fire Extinguisher List - (must be tagged annually) (72000-7 3/22 PDF)
- Guidance: Poisonous Plants in Family Child Care (DHS-7745 PDF)
- Licensing Requirement Dispute - Family Child Care (DHS-7966 PDF)
- Licensing Requirements - Family Child Care (DHS-7775 PDF)
- Monthly Crib Safety Inspection Form (DHS-7743 PDF)
- Monthly Drill Log - Child Care Homes (72000-63 11/19 PDF)
- Permission for Fire Inspection - Property Owners (Minnesota Dept. of Public Safety PDF)
- Physician’s Report (DHS-1995 PDF)
- Provider Training Record-CC (72000-27 4/21 PDF)
- Serious Injury Reporting Form - Family Child Care (DHS-7774 PDF)
- Substitute Tracking-Child Care Licensing (72000-153 11/19 PDF)
- Variance Request-Family Child Care (DHS-7297 PDF)
- Variance Request Form - Extended Use of Substitutes - Family Child Care (DHS-7964 PDF)
- Variance Request-Notice for Parents (DHS-7297B PDF)
- Child Care Provider's Policies and Contract-SAMPLE (PDF)
- Family Child Care Admission and Arrangements Form (DHS-7776 PDF)
- Family Child Care Allergy Information Form (DHS-7736 PDF)
- Immunization Form (MDH PDF)
- Infant Rolling Over Parent Statement for Infant Less Than Six Months Old (DHS-7219 PDF)
- Liability Insurance Notice to Parents or Guardians (DHS-7741 PDF)
- Maltreatment of Minors Mandated Reporting Form (DHS-7634C PDF)
- Permission to Administer Medication (72000-8 3/13 PDF)
- Permission to Administer Non-Prescription Products (72000-9 3/13 PDF)
- Physician Directive for Alternative Infant Sleep Position (DHS-7216 PDF)
- Rule and Statute Summary - Family Child Care (DHS-7747 PDF)
- Swaddling Consent for an Infant (DHS-7218 PDF)
- Swimming Pool Permission Form (DHS-7749A PDF)
- Swimming Pool Risks (DHS-7749B PDF)
- Travel and Activity Authorization (72000-57 8/11/10 PDF)
- Wading Pool Permission Form (DHS-7749C PDF)
- Wading Pool Risks (DHS-7749D PDF)