Texas Daycare and Child Care Forms

Child Care Licensing Forms for Providers – Day Care

The Child Care Licensing Division provides the following forms for use by:

  • child care providers
  • child care centers
  • registered child-care homes
  • licensed child-care homes
  • child-placing agencies
  • emergency shelters
  • foster homes
  • foster group homes
  • agency foster group homes

While these forms can be used for documenting information required by the Minimum Standards, their use is not mandated by Child Care Licensing.

Forms

Click on ‘PDF’ below to download the Adobe Acrobat version of a form or on ‘DOC’ to download the Microsoft Word version. Use ‘CTRL + F’ to find specific form titles.

DFPS Privacy and Security Policy

NumberForm Name Description of Use for Providers

Discipline and Guidance Policy (pdf) (doc)

Texas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance

7239 Incident/Illness Report (pdf) (doc)

Details of incident that caused injury or placed child at risk.

1100 Daily Building & Grounds Safety Checklist (pdf, doc)
2841 SEBCC Application Form (pdf | doc)
2842 SEBCC Application Inspection Letter (pdf | doc )
2843 SEBCC Issuance Letter (pdf | doc)
2821 Exemption Determination (pdf, doc)
2846 Gang Free Zone Tip Sheet for Providers and Parents (pdf, doc)

House Bill 2086 passed during the 81st Legislature, Regular Session, modified Chapter 42 of the Human Resource Code to include Section 42.064, effective September 1, 2009. This new statute requires that information about gang-free zones be distributed to parents and guardians of children in care at licensed child care centers.

2869 Listed Family Home introduction letter (pdf | doc)
2873 Guidelines for listed family homes (pdf | doc)
2885 Children’s Products Certification (pdf | doc)
2904 Authorization for Emergency Medical Treatment (pdf) (doc)

By using this form, parents may give clear instructions for emergency medical treatment for their children.

2935 Admissions Information – Centers (pdf) (doc)
Facilities must keep certain information for licensing regulations and the Child & Adult Care Food Program (CACFP). This form prevents duplication of effort by providers by keeping only 1 enrollment form for both programs. The CACFP program requires enrollment information to be updated annually.
2937 Child Care Waiver/Variance Request Form (pdf, doc)

To request a Minimum Standard waiver or variance

2940 Child Care Administrative Review Request Form (pdf) (doc)

To request an administrative review

2947p Center Base Staff Information Record (pdf) (doc)

This information is required by rule and simplifies form completion for providers to have records available.

2955e Licensing Fee Information (pdf) (doc)

This is an informational form to let providers know the various fees and requirements of TDFPS.

2957 Parent Notification Poster for Center Based Care (pdf) (doc)

This poster list information you are entitled to see as required from the center Director.

2957b Parent Notification Poster for Home Based Care (pdf) (doc)
This poster list information you are entitled to see as required from the primary caregiver.
2965 FAST Pass for day care applicants (pdf) | (doc)

Required Materials to Grant Services

2971 Request for Criminal History check/Central Registry Check (pdf, doc)

This information is required by DFPS and simplifies form completion for providers. Reduces errors in the information that must be presented to request these checks.

2982 Personal History Statement – CPA (pdf) (doc)

This information is required by DFPS and simplifies form completion for providers.

2985e Affidavit for Applicants for Employment With a Licensed Operation or Registered Child-Care Home (pdf) (doc)

This information is required by law and simplifies form completion for staff of providers.

2986E Listing request (pdf, doc)

Form to become a listed home

2988A Child Care Fee Schedule (pdf) (doc)

This form needs to be submitted with any type fee for all regulated facilities.

7238 Authorization For Dispensing Medication (pdf) (doc)

This information is required by DFPS and simplifies form completion for providers.

7240 Monthly Attendance Record (pdf) (xls)

This information is required by DFPS and simplifies form completion for providers.

7242 Registered Family Home Caregiver/Parent Agreement (pdf, doc)
7243 Emergency Telephone Numbers RFH (pdf) (doc)

This information is required by DFPS and enables providers to post information in a readable manner.

7255E Medication Authorization Form (pdf) (doc)
Medication Authorization Form
7261 Information on Reporting Child Abuse (pdf) (doc)

This form gives information to those who suspect child abuse and enables providers and parents to know the law.

7263 Fire Safety Practices (pdf, doc)
7293 Child Assessment Form (pdf, doc)

Child Care Licensing Forms for Providers – Residential Care

The Child Care Licensing Division provides the following forms for use by:

  • child care providers
  • child care centers
  • registered child-care homes
  • licensed child-care homes
  • child-placing agencies 24-hour care facilities
  • emergency shelters
  • foster homes
  • foster group homes
  • agency foster group homes

While these forms can be used for documenting information required by the Minimum Standards, their use is not mandated by Child Care Licensing.

NumberForm Name Description of Use for Providers

Address Correction Form for Licensed Child Care Administrators and Licensed Child-Placing Agency Administrators (pdf, doc)
2760 Controlling Person Form (pdf) (doc)Required for Residential Operations to identify who is ultimately responsible for complying with standards and keeping children safe.
2778 Child Placing Agency Standards (pdf) (doc)
Guidelines for Materials Required Prior to Issuance 2779 Consolidated Standards (pdf) (doc)

Guidelines for Materials Required Prior to Issuance 2781 Independent Foster Home Rules:

Evaluated Prior to Issuing an Initial License to a Non-Operating Home (pdf, doc)
2783 Maternity Home Standards (pdf) (doc)
Guidelines for Materials Required Prior to Issuance 2784
General Residential Operation and Residential Treatment Center Documentation Required at Application (pdf, doc)
Additional Guidelines for Materials Required to Accept Application 2785
Child-Placing Agency Documentation Required at Application (pdf, doc)
Additional Guidelines for Materials Required to Accept Application 2786
Independent Foster Home Documentation Required at Application(pdf, doc)
Additional Guidelines for Materials Required to Accept Application 2787
Maternity Home Documentation Required at Application (pdf, doc)
Additional Guidelines for Materials Required to Accept Application 2821
Exemption Determination (pdf, doc)
2885 Children’s Products Certification (pdf | doc)
2987 No Contact Letter to CPA (pdf, doc)
2904 Authorization for Emergency Medical Treatment (pdf) (doc)

By using this form, parents may give clear instructions for emergency medical treatment for their children.

2906 CPA InternalInvestigation Report (pdf, doc)

Voluntary form for CPA internal investigations.

2934 Medical History Report (doc, pdf)

New legislation requires a parent who voluntarily relinquishes their parental rights of their biological child and parents whose rights are terminated to complete this form describing theirs and their ancestors medical history.

2937 Child Care Waiver/Variance Request Form (pdf, doc)

To request a Minimum Standard waiver or variance

2940 Child Care Administrative Review Request Form (pdf) (doc)

To request an administrative review

2946 Local Law Enforcement Background Check Results for Prospective Foster Parents (doc)

2954 Disclosure of Any Family Violence Calls to a Prospective Foster Home Applicants Place of Residence (doc)
2955 Licensing Fee Information (pdf) (pdf in Spanish) (doc) (doc in Spanish) This is an informational form to let providers know the various fees and requirements of TDFPS.
2961 Request to Accept Children from Law Enforcement (doc, pdf) This form must be submitted by a Child Placing Agency prior to them accepting children from a Law Enforcement Officer.
2963 FAST Pass for Foster Adoptive Applicants (pdf) (doc)

Required Materials to Grant Services

2964 FAST Pass for residential applicants (pdf) (doc)

Required Materials to Grant Services

2971 Request for Criminal History check/Central Registry Check (pdf, doc)

This information is required by DFPS and simplifies form completion for providers. Reduces errors in the information that must be presented to request these checks.

2982 Personal History Statement – CPA (pdf) (doc) This information is required by DFPS and simplifies form completion for providers.
2985e Affidavit for Applicants for Employment With a Licensed Operation or Registered Child-Care Home (pdf) (doc)

This information is required by law and simplifies form completion for staff of providers.

2988A Child Care Fee Schedule (pdf) (doc)

This form needs to be submitted with any type fee for all regulated facilities.

2993 Administrative Penalty Fee form (pdf) (doc)
Administrative Penalty Fee Form 7261 Information on Reporting Child Abuse (pdf) (doc)

This form gives information to those who suspect child abuse and enables providers and parents to know the law.

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