Indiana Daycare and Child Care Forms
Becoming a Licensed or Registered Provider
http://www.in.gov/fssa/carefinder/2736.htm
Indiana Child Care Provider Forms
http://www.in.gov/fssa/carefinder/2733.htm
Licensed Centers
- Application for Child Care Center Variance or Waiver
- Application for Construction Permit for Child Care Facility – State Form 49454
- Attestation Statement – State Form 48629/BCC 0012
- Breast milk Procedure 49954 (R/12-06)/BCC 0067
- Consent to Release Information for Licensed Centers, Licensed Homes, Unlicensed Registered Ministries, and CCDF LLEPs – State Form 53323 (R2/3-10) / BCC 0330
- Health Care Program for Child Care Centers: Child Care Center Health Record – State Form 49969 (R2/11-06)/ BCC 0019
- Healthcare Program for Childcare Centers – State Form 45877/BCC 0054
- History of Immunizations – State Form 49445/BCC 0036
- Injury Report Form for Licensed Child Care Centers
- Licensed Child Care Center / Home Consent – State Form 50548(R2/7-06)/BCC 0080
- Monthly Report of Licensed Child Care Centers and Homes (As Required by IC 12.17.2-2-1.5) – State Form 46789 (R/10-09)/BCC 0007
- Provider Response Form – State Form 53320 (7-07) BCC 0312
- Request for Limited Adult Criminal History Information – State Form 53320
- Review / Assessment for Child Care Centers 46153 (R3/7-07)BCC 0320
- Safe Transportation of Food Responsibility Agreement
- Sample Intake Agreement Form
- Sample New Employee Orientation Form
- Sanitation/Sterilization Procedures for Bottles, Nipples, Collars, Caps 49953 (R2/12-06)/BCC 0066
- Sanitizing Solutions 49973/BCC 0024
- Supplement to Health Program Form – Infant/Toddler 45878/BCC 0055
- Taxpayer Identification Number Request (W-9) 23743
- Training Record Log
- Verification and Documentation of Universal Precautions Training Form
- Written Nutrition Food Service Program for Child Care Centers 46684/BCC 0051
- Written Nutrition Food Service Program Infant/Toddler Child Care Centers 46682/BCC 0053
Licensed Homes
- Application for Child Care Home Variance or Waiver 48269 (R/6-07)/BCC 0025
- Attestation Statement 48629/BCC 0012
- Breast milk Procedure 49954 (R/12-06)/BCC 0067
- Child Care Home Injury Report (Medical Attention Needed) State Form 54265 (5-10) / BCC 0221
- Child Care Home Licensing Report – State Form 46739 (R2/3-05)/ BCD 0011
- Consent to Release Information for Licensed Centers, Licensed Homes, Unlicensed Registered Ministries, and CCDF LLEPs – State Form 53323 (R2/3-10) / BCC 0330
- Healthcare Program for Childcare Centers 45877/BCC 0054
- History of Immunizations 49445/BCC 0036
- Licensed Child Care Center / Home Consent – State Form 50548(R2/7-06)/BCC 0080
- Monthly Report of Licensed Child Care Centers and Homes (As Required by IC 12-17.2-2-1.5) – State Form 46789 (R/10-09)/BCC 0007
- PTQ Voluntary Decline Form
- Provider Response Form – State Form 53320 (7-07) BCC 0312
- Sanitizing Solutions 49973/BCC 0024
- Taxpayer Identification Number Request (W-9) 23743
- Verification and Documentation of Universal Precautions Training Form
Registered Ministries
- Application for Voluntary Certificate of Recognition 49443/BCC 0034
- Attestation Statement 48629/BCC 0012
- Breast milk Procedure 49954 (R/12-06)/BCC 0067
- Checklist For Registered Child Care Ministries Sanitation Survey 49441 (R5/9-07)/BCC 0032
- Child Care Development Fund (CCDF) Provider Eligibility Standards (PES) Checklist, State Form 51363/BCC 0091
- Consent to Release Information for Licensed Centers, Licensed Homes, Unlicensed Registered Ministries, and CCDF LLEPs – State Form 53323 (R2/3-10) / BCC 0330
- History of Immunizations 49445/BCC 0036
- PTQ Voluntary Decline Form
- Provider Response Form – State Form 53320 (7-07) BCC 0312
- Request for Limited Adult Criminal History Information -State Form 8053
- Sanitation/Sterilization Procedures for Bottles, Nipples, Collars, Caps 49953 (R2/12-06)/BCC 0066
- Sanitizing Solutions 49973/BCC 0024
- Taxpayer Identification Number Request (W-9) 23743
- Verification and Documentation of Universal Precautions Training Form
LLEP’s (Legally Licensed-Exempt Providers)
- Child Care Development Fund (CCDF) Provider Eligibility Standards (PES) Checklist, State Form 51363/BCC 0091
- Consent to Release Information for Licensed Centers, Licensed Homes, Unlicensed Registered Ministries, and CCDF LLEPs – State Form 53323 (R2/3-10) / BCC 0330
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