Kansas Daycare and Child Care Forms

Licensed and Group Day Care (LDCH/GDCH) Forms

Note – Forms for parents to complete are indicated in red.

*Indicates forms to be submitted to KDHE

Instructions for Completing CCL 201 02/2009
*CCL 201 Application 02/2009 en EspañolCL 201
*CCL 002 Request for KBI/SRS Registry Check 02/2010 en EspañolCL 002
*Fire/Life Safety Agreement (located at www.ksfm.ks.gov)

Portfolio Supplemental Forms in the LDCH/GDCH application packet

Supplemental Forms for the LDCH/GDCH
CCL 005 Yearly Mechanical Safety Check 02/2010 en EspañolCL 005
CCL 009 Health Assessment, 16 & Older 02/2010 en EspañolCL 009
CCL 010 Authorization for Emergency Medical Care 02/2010 en EspañolCL 010
CCL 026 Short-Term Medication Authorization 02/2010 en EspañolCL 026
CCL 027 Long-Term Medication Authorization 02/2010 en EspañolCL 027
CCL 028 Notification of Injury, Illness, Critical Incident 02/2010
CCL 029 & 029a Child Medical Record, Immunization History, & Health Assessment 02/2009
CCL 034 Parental Permission, Off-Premise Trips 02/2010 en EspañolCL 034
CCL 035 Parental Permission, Off-Premise, Group Trips 02/2010 en EspañolCL 035
CCL 204 Provider’s Self-Evaluation Checklist 09/2003
CCL 206 Report of Directed Readings 09/2003
CCL 207 Record of Observations 09/2003

Additional forms not in the application packet
CCL 031 Request for Exception 09/2003
CCL 032 Request for Amendment 09/2003 en EspañolCL 032
CCL 205 Schedule of Enrollment 09/2003

More Daycare Resources

Comments on this entry are closed.