Forms for Child Care
Background Studies
Class Worksheets
- 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).
Emergency/Safety
- Child Care Emergency Plan-DHS-7955 (PDF).
- Fire Extinguisher List-72000-7 3/22 (PDF) (must be tagged annually).
- Guidance: Poisonous Plants in Family Child Care-DHS-7745 (PDF).
- Monthly Crib Safety Inspection Form-DHS-7743 (PDF).
- Monthly Drill Log - Child Care Homes-72000-63 11/19 (PDF).
- Serious Injury Reporting Form - Family Child Care-DHS-7774 (PDF).
Miscellaneous
- 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).
- Electronic Data Consent-70000-21 9/20 (PDF).
- Family Child Care Request for Expedited Correction Order Reconsideration-DHS-TCM-1053-327240 (PDF).
- Family Child Care Weekly Attendance Schedule-DHS-7297A (PDF).
- Licensing Requirement Dispute - Family Child Care-DHS-7966 (PDF).
- Physician’s Report-DHS-1995 (PDF).
- Provider Training Record-CC-72000-27 11/25 (PDF).
- Substitute Tracking-Child Care Licensing-72000-153 11/19 (PDF).
Variances
Miscellaneous
- 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-Are Your Kids Ready-MDH-80154 (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).
- Rule and Statute Summary - Family Child Care-DHS-7747 (PDF).
- Travel and Activity Authorization-72000-57 8/11/10 (PDF).
Pools
- Swimming Pool Permission Form-DHS-7749A (PDF).
- Swimming Pool Risks-DHS-7749B (PDF).
- Wading Pool Permission Form-DHS-7749C (PDF).
- Wading Pool Risks-DHS-7749D (PDF).
Safe Infant Sleep
- Cradleboard Variance Request Form-DHS-8529 (PDF).
- Helmet Approval for Sleeping Infant-DHS-8531 (PDF).
- Infant Rolling Over Parent Statement for Infant Less Than Six Months Old-DHS-7219 (PDF).
- Parent Cradleboard Request-DHS-8536 (PDF).
- Physician Directive for Alternative Infant Sleep Position-DHS-7216 (PDF).
- Swaddling Consent for an Infant-DHS-7218 (PDF).