Utah Daycare and Child Care Forms

APPLICATION INFORMATION

The following pdf files need Adobe Reader to be opened.

Center, Hourly and Out of School Care

Steps to Obtaining a Center, Out of School Time, or Hourly Center Child Care License (pdf) (01/2010)

New Application (Central) (South) (04/2010)
Renew Application (Central) (South) (03/2010)
Changes Application (Central) (South) (9/1/09)

Licensed Family & Residential Certificate

Steps for Obtaining a Family Child Care License (pdf) (7/09)
Steps for Obtaining a Residential Certificate Child Care License (pdf) (7/09)
New Application (North) (Central) (South) (03/2010)
Renew Application (North) (Central) (South) (03/2010)
Change Application (North) (Central) (South) (7/7/09)
Basic Requirements for Licensed Family and RC Providers (comparison) (pdf)

Request for Verification of Exempt Status

Application (North) (Central) (South)
Background Clearance Renewal Process (pdf)
Renewal Background Clearance for Family and Residential Certificate (Northern) (Central) (Southern)
Renewal Background Clearance for Center and Hourly Center (Northern) (Central) (Southern)
Background Clearance Disclosure Statement (pdf)

All Providers

Admission Agreement and Health Assessment (pdf-English) (pdf-Spanish) (08/2009)
Approved Menus (pdf) (08/2008)
Article on the Dangers of Infant Car Seats (pdf) (09/2009)
Behavioral Expectations & Discipline of Children (pdf) (11/2008)
Business License & Fire Inspection Contacts
(North) (Central for Center Providers) (Central for Home Providers) (South) (04/2009)
Child Abuse Reporting Guide (pdf) (09/2008)
Child Care Agency List by County (pdf) (10/2008)
CPSC Crib Toy Safety Alert (pdf) (09/2009)
CPSC Infant Strings & Necklaces Alert (pdf) (09/2009)
CPSC Toy Strings & Cords Alert (pdf) (09/2009)
CPSC Window Cord Safety Alert (pdf) (09/2009)
Daily Sign In & Out Form (pdf) (08/2008)
Do not Let Sleeping Babies Lie-in Car Seats (pdf) (08/2008)
First Aid and CPR Training Sources (link)
Guide to Safe Sleep (pdf)
Handwashing Procedures Poster (pdf) (08/2008)
Illness Information and Prevention Guidelines For Child Care Centers (pdf)
Immunization Information (link)
Infant & Toddler Food Sizes (pdf) (10/2009)
Medication Permission & Administration Form (pdf) (08/2008)
Medication Permission & Administration Form (Spanish Version) (04/2009)
Monthly Individual Child Sign In & Out (pdf) (08/2008)
Number Required Training Hours for Newly Hired Staff (pdf) (09/2008)
Poisonous Plants and Safe Plants (pdf) (01/2008)
Posting Emergency Number (pdf) (05/2009)
SIDS Safe Sleeping Guide(pdf) (11/2009)
Utah’s Booster Seat Law Commonly Asked Questions (pdf) (11/2008)
Weather Watch (pdf) (09/2009)

Center, Hourly, Out of School Program Providers
— For additional forms, see “All Providers” above.

Click here to get Center Renewal Forms

Accident Report (WordPerfect) (pdf) (03/2010) – Hourly only
Admission Agreement (WordPerfect) (pdf) (03/2010) – Hourly only
Annual Training Log with Topics (pdf) – Hourly only
Annual Training Log without Topics (pdf) – Hourly only
Child Admission Agreement & Health Assessment (pdf) – Hourly only
Children’s Records (WordPerfect) (pdf) (03/2010) – Hourly only
Diapering Procedure (pdf) (08/2008)
Director Designee Authorization (pdf) (08/2008)
Director Qualifications (pdf) (09/2009)
Director Qualifications (pdf) (06/2010) – Out of School Only
Do not Let Sleeping Babies Lie-in Car Seats (pdf) (08/2008)
Emergency & Disaster Plan Template (Word) (WordPerfect) (pdf) (09/2009) – Center only
Emergency & Disaster Plan Template (Word) (wordPerfect) (pdf) – Hourly only
Emergency & Disaster Plan Template (word) (wordPerfect) (pdf) – Out of School only
Fire & Disaster Drill Log (pdf) (04/2010)
Fire & Disaster Drill Log (WordPerfect) (pdf) (03/2010) – Hourly only
Infant Daily Record (pdf) (08/2008)
Infant Daily Record 5 Days (pdf) (08/2008)
Infant Daily Record 7 Days (pdf) (08/2008)
Medication Permission Form (pdf) (03/2010) – Hourly only
Minor Accident, Incident, or Injury Report (pdf) (05/2010)
Orientation Training Log (pdf) – Hourly only
Parents Guide (pdf) (06/2009) – Center only
Parents Guide (pdf) (01/2010) – Out of School only

Playground Inspection Tools (Click on “Complete” Inspection/Audit Tool Kits on left menu)

Policies and Procedures for Center (Word) (WordPerfect) (pdf) (09/2009) – Center only
Policies and Procedures for After School (Word) (WordPerfect) (pdf) (03/2010) – Out of School only
Ratios Chart (pdf) – Hourly only
Required Records (pdf) (01/2010) – Center and Out of School only
Required Records Checklist (pdf) – Hourly only
Required Records Checklist — Children’s Documentation (pdf) – Hourly only
Serious Accident, Incident, or Injury Report (pdf) (05/2010)
Sign In & Out Form (pdf) (03/2010) – Hourly only
Staff Orientation (WordPerfect) (pdf) (03/2010) – Hourly only
Structural Rules for Child Care Centers (pdf) (01/2009)
Summary of Cushioning Materials (pdf) (08/2008)
Training Log (pdf) (03/2010) – Hourly only
Training Topics Handout (pdf) (09/2009) – Center only

What to Expect During Your Inspection (pdf) (06/2010)

Home Providers (Licensed Family and Residential Certificate)

— For additional forms, see “All Providers” above.

Catch-up Immunization Schedule (pdf) (12/2009)
Checking Immunization Records (pdf) (12/2009)
Emergency & Disaster Plan Template (WordPerfect) (pdf) (Spanish) (10/2009)
Emergency Substitute Statement (pdf) (10/2008)
Fire & Disaster Drill Log (pdf) (Spanish) (04/2010)
Minor Accident, Incident, or Injury Report (pdf) (08/2008)
Orientation Training Log (pdf) (08/2008)
Orientation Training Log for RC (pdf) (08/2008)
Parents Guide to Licensed Family (pdf) (01/2010)
Parents Guide to RC (pdf) (01/2010)
Policies and Procedures for Family Template (WordPerfect) (pdf) (10/2009)
Required Records for Family (pdf) (08/2008)
Serious Accident, Incident, or Injury Report (pdf) (08/2008)
School Age Daily Sign In-Out.pdf (pdf) (03/2010)
School Age Monthly Sign in-out.pdf (pdf) (03/2010)
Training Log with Topics for Family (pdf) (05/2010)
Training Log with Topics for RC (pdf) (05/2010)
Training Log without Topics(pdf) (08/2008)
Trampoline Use Permission (pdf) (08/2008)
What to Expect During Your Inspection (pdf) (06/2010)
Wood Burning Stoves & Fireplaces in Child Care Homes(pdf) (03/2010)

More Daycare Resources

Comments on this entry are closed.