Connecticut Daycare and Child Care Forms
FORMS GUIDE
http://www.ct.gov/dph/cwp/view.asp?a=3141&q=387162&dphNav_GID=1823&dphNav=|
Forms and Applications
- Family Day Care
- Group Day Care Home/ Child Day Care Center
Family Day Care Licensure Applications
- Application – Initial (pdf)
- Application – Renewal
- Renewal Cover Letter (pdf)
- Renewal Fee Invoice Form (pdf)
- Change of Address Application (pdf)
- Application – Family Day Care Home Staff (pdf)
- Renewal Application Cover Letter (pdf)
- Renewal Application – Family Day Care Home Staff (pdf)
Related Forms
- Adult Medical Statement for Child Day Care (pdf)
- Authorization for the Administration of Medication by Child Day Care Personnel (pdf)
- Parent/Guardian Authorization for the Administration of Non-Prescription Topical Medication (pdf)
- Child Day Care Incident Log (pdf)
- Child Enrollment (pdf)
- DCF Authorization for Release of Information (pdf)
- Early Childhood Health Assessment Record (pdf)
- Emergency Medical Care (pdf)
- Emergency Telephone Numbers (pdf)
- General Report of Change (pdf)
- Family Day Care Inspection Form (Sample) (pdf)
Group Day Care Home/Child Day Care Center Licensure Applications
Application – Initial
- Initial Application Cover Letter (pdf)
- Application Checklist (pdf)
- Initial Application Fee Invoice Form (pdf)
- Affidavit (pdf)
- Application for Initial License (pdf)
- Supplementary Information for Infant/Toddler Care (pdf)
- “Sample” Policies, Plans & Procedures (pdf)
Application – Renewal
- Renewal Cover Letter (pdf)
- Renewal Fee Invoice Form (pdf)
Related Applications
- Early Childhood Education Consultant (pdf)
- Head Teacher – Group (pdf)
- Head Teacher – Center (pdf)
- Head Teacher – School Age (pdf)
Related Forms
- Approval for Child Day Care (pdf)
- Authorization for the Administration of Medication by Child Day Care Personnel (pdf)
- Parent/Guardian Authorization for the Administration of Non-Prescription Topical Medication (pdf)
- Child Day Care/Group Day Care Home Inspection Form (Sample) (pdf)
- Consultant/Head Teacher Data Sheet (pdf)
- DCF Authorization for the Release of Information (pdf)
- Early Childhood Health Assessment Record (pdf)
- Fire Marshall Inspection Certificate (pdf)
- Individual Staff Professional Development (pdf)
- Notification of Proposed Changes (pdf)
- Property History Questions for Daycare Center Applications (pdf)
- Staff Health Record Result of Tuberculin Test and Statement of Health Status (pdf)
- Staff Work Schedule (pdf)
- Water Supply (pdf)
- Worker’s Compensation Insurance Form (pdf)
To Obtain Blank Fingerprint Cards and DCF Release of Information Forms Contact:
Legal Office CT Department of Public Health
410 Capitol Avenue MS #12 LEG
P.O. Box 340308
Hartford, CT 06134-0308
Telephone #: 860-509-7600
http://www.ct.gov/dph/cwp/view.asp?a=3141&q=387172&dphNav_GID=1823&dphNav=|
Provider Information
First Aid
- Approved First Aid Courses for Child Day Care (pdf)
- CPR Courses for Child Day Care Providers (pdf)
- First Aid Training Memo to Child Day Care Centers and Group Homes (pdf)
- First Aid Kit Items (pdf)
- CPR and Lifeguard Requirements During Swimming or Wading Activities (pdf)
Technical Assistance
- Guidelines for Abuse Neglect Policies and Procedures (pdf)
- Guide to the Child Day Care Investigation and Hearing Process (pdf)
- Hand Sanitizer Fact Sheet (pdf)
- Interim Plans for Head Teachers (pdf)
- Organizing Your Current Licensing Application (pdf)
- Supervisors List by Towns/Resolving Disputed Violations (pdf)
- Technical Assistance Request Form (pdf)
- Use of Consultants (pdf)
Miscellaneous:
- Complaint Procedure (pdf)
- CT Immunization Requirements Schedule (pdf)
- Check List – Petition for Special Medication Authorization (pdf)
- MRSA Factsheet for Child Day Care Programs (pdf)
- Medication Administration Training (pdf)
- Witness Statement (pdf)
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