Washington Daycare and Child Care Forms

Licensing Forms & Documents for Providers

General Licensed Child Care Forms School-Age and Center Provider Forms Family Home Provider Forms News and information

To download a document below right click on one of the links to save it to your hard drive. You can also click on the link directly to open it in its originating Program. Click here to find DEL licensing policies and procedures that guide our licensing work.

General Licensed Child Care Forms

Background Check Form
Background check form for child care workers.

Background Check Form File Format: Adobe Acrobat (PDF) [49k]
Background Check Form (Spanish) File Format: Adobe Acrobat (PDF) [51k]

Background Check Form File Format: Microsoft Word (DOC) [253k]

Background Check Form (Spanish) File Format: Microsoft Word (DOC) [271k]

Certificate of Immunization Status Form

Washington State Department of Health Certificate of Immunization Status form.

Certificate of Immunization Status Form (English) File Format: Adobe Acrobat (PDF) [100k]
Certificate of Immunization Status Form (Spanish) File Format: Adobe Acrobat (PDF) [177k]

Child Care Agreement
Financial agreement.

Child Care Agreement File Format: Adobe Acrobat (PDF) [26k]
Child Care Agreement (Spanish) File Format: Adobe Acrobat (PDF) [31k]

Child Care Agreement File Format: Microsoft Word (DOC) [185k]

Child Care Agreement (Spanish) File Format: Microsoft Word (DOC) [188k]

Child Care Registration

Child Care Registration Form.

Child Care Registration File Format: Adobe Acrobat (PDF) [41k]
Child Care Registration (Spanish) File Format: Adobe Acrobat (PDF) [48k]
Child Care Registration File Format: Microsoft Word (DOC) [219k]
Child Care Registration (Spanish) File Format: Microsoft Word (DOC) [210k]

Daily Attendance Records
Attendance record form for child care facilities.

Daily Attendance Records File Format: Adobe Acrobat (PDF) [244k]
Daily Attendance Records (Spanish) File Format: Adobe Acrobat (PDF) [28k]
Daily Attendance Records File Format: Microsoft Word (DOC) [81k]
Daily Attendance Records (Spanish) File Format: Microsoft Word (DOC) [257k]

Fire Safety Record

Fire Safety Record and Evacuation Plan.
Fire Safety Record File Format: Adobe Acrobat (PDF) [202k]
Fire Safety Record (Spanish) File Format: Adobe Acrobat (PDF) [220k]
Fire Safety Record File Format: Microsoft Word (DOC) [208k]
Fire Safety Record (Spanish) File Format: Microsoft Word (DOC) [210k]

Injury/Incident Report

Child injury form.
Injury/Incident Report File Format: Adobe Acrobat (PDF) [84k]
Injury/Incident Report (Spanish) File Format: Adobe Acrobat (PDF) [41k]
Injury/Incident Report File Format: Microsoft Word (DOC) [198k]
Injury/Incident Report (Spanish) File Format: Microsoft Word (DOC) [77k]

Reconsideration Request Form
Form to request a reconsideration.
Reconsideration Request Form File Format: Adobe Acrobat (PDF) [33k]
Reconsideration Request Form File Format: Microsoft Word (DOC) [184k]

School Based and Military Certification for Payment Only Request Form
Form to request certification for payment only.
School Based and Military Certification for Payment Only Request Form File Format: Adobe Acrobat (PDF) [50k]
School Based and Military Certification for Payment Only Request Form File Format: Microsoft Word (DOC) [170k]

Tribal Certification Request Letter Template

Form to request Tribal certification for payment only.
Tribal Certification Request Letter Template File Format: Adobe Acrobat (PDF) [6k]
Tribal Certification Request Letter Template File Format: Microsoft Word (DOC) [41k]

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School-Age and Center Provider Forms

Child Care Center Director/Program Supervisor Notice of Change

Child care center or school age director/program supervisor notice of change.
Child Care Center Director/Program Supervisor Notice of Change File Format: Adobe Acrobat (PDF) [56k]
Child Care Center Director/Program Supervisor Notice of Change File Format: Microsoft Word (DOC) [184k]

Child Care Center Feasibility Checklist

Licensing checklist form for child care centers.
Child Care Center Feasibility Checklist File Format: Adobe Acrobat (PDF) [109k]
Child Care Center Feasibility Checklist File Format: Microsoft Word (DOC) [217k]

Child Care Center Licensing Checklist

Licensing checklist form for child care centers.
Child Care Center Licensing Checklist File Format: Adobe Acrobat (PDF) [217k]
Child Care Center Licensing Checklist File Format: Microsoft Word (DOC) [681k]

Child Care Center Monitoring Checklist

Monitoring checklist form for child care centers.
Child Care Center Monitoring Checklist File Format: Adobe Acrobat (PDF) [217k]
Child Care Center Monitoring Checklist File Format: Microsoft Word (DOC) [681k]

Center and School-Age Licensing Application

Licensing Application form for Centers & School-age facilities. You must attend DEL orientation before submitting a licensing application.

Center and School-Age Licensing Application File Format: Adobe Acrobat (PDF) [223k]
Center and School-Age Licensing Application File Format: Microsoft Word (DOC) [570k]

Center and School-Age Application for Employment

Application for Employment in a licensed child care facility.

Center/SA Application for Employment File Format: Adobe Acrobat (PDF) [174k]
Center/SA Application for Employment File Format: Microsoft Word (DOC) [360k]

Center File Review Checklist

File review checklist form for child care centers.

Center File Review Checklist File Format: Adobe Acrobat (PDF) [107k]
Center File Review Checklist File Format: Microsoft Word (DOC) [202k]

Center Probation Notification Letter to Parents

Letter to inform parents the center is operating with a probationary child care license under the following conditions.

Center Probation Notification Letter to Parents File Format: Adobe Acrobat (PDF) [35k]
Center Probation Notification Letter to Parents File Format: Microsoft Word (DOC) [38k]

School-Age Licensing Checklist

Licensing Checklist form for School-age Programs.

School-Age Licensing Checklist File Format: Adobe Acrobat (PDF) [210k]
School-Age Licensing Checklist File Format: Microsoft Word (DOC) [480k]

School-Age Monitoring Checklist

Licensing Checklist form for School-age Programs.

School-Age Monitoring Checklist File Format: Adobe Acrobat (PDF) [210k]
School-Age Monitoring Checklist File Format: Microsoft Word (DOC) [480k]

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Family Home Provider Forms

Family Home Liability Insurance Exemption

A form regarding insurance status.

Insurance Notification File Format: Adobe Acrobat (PDF) [8k]
Insurance Notification File Format: File Format: Microsoft Word (DOC) [24k]

Family Home Licensing Application

Licensing Checklist form for Family Home Child Care. You must attend DEL orientation before submitting a licensing application.

Licensing Application form for Family Home Child Care File Format: Adobe Acrobat (PDF) [250k]
Licensing Application form for Family Home Child Care (Spanish) File Format: Adobe Acrobat (PDF) [283k]
Licensing Application form for Family Home Child Care File Format: Microsoft Word (DOC) [280k]
Licensing Application form for Family Home Child Care (Spanish) File Format: Microsoft Word (DOC) [279k]

Family Home Licensing Checklist

Licensing Checklist form for Family Home Child Care.

Family Home Licensing Checklist File Format: Adobe Acrobat (PDF) [250k]
Family Home Licensing Checklist (Spanish) File Format: Adobe Acrobat (PDF) [283k]
Family Home Licensing Checklist File Format: Microsoft Word (DOC) [280k]
Family Home Licensing Checklist (Spanish) File Format: Microsoft Word (DOC) [279k]

Family Home Monitoring Checklist

Monitoring Checklist form for Family Home Child Care.

Family Home Monitoring Checklist File Format: Adobe Acrobat (PDF) [181k]
Family Home Monitoring Checklist (Spanish) File Format: Adobe Acrobat (PDF) [189k]
Family Home Monitoring Checklist File Format: Microsoft Word (DOC) [280k]
Family Home Monitoring Checklist (Spanish) File Format: Microsoft Word (DOC) [279k]

Family Home Permission Authorization

Parent/guardian permission authorization form for family home child care.

Family Home Permission Authorization File Format: Adobe Acrobat (PDF) [37k]
Family Home Permission Authorization (Spanish) File Format: Adobe Acrobat (PDF) [25k]
Family Home Permission Authorization File Format: Microsoft Word (DOC) [42k]
Family Home Permission Authorization (Spanish) File Format: Microsoft Word (DOC) [166k]

Family Home Probation Notification Letter to Parents from Provider

Parent/guardian permission authorization form for family home child care.

Probation Notification Letter File Format: Adobe Acrobat (PDF) [35k]
Probation Notification Letter File Format: Microsoft Word (DOC) [34k]

Family Home Provider/Assistant Resume Form

Provider/assistant resume form for family home child care.

Family Home Provider/Assistant Resume Form File Format: Adobe Acrobat (PDF) [55k]
Family Home Provider/Assistant Resume Form (Spanish) File Format: Adobe Acrobat (PDF) [38k]
Family Home Provider/Assistant Resume Form File Format: Microsoft Word (DOC) [99k]
Family Home Provider/Assistant Resume Form (Spanish) File Format: Microsoft Word (DOC) [243k]

Family Home Request to Change Capacity

Family child care capacity change request form.

Family Home Request to Change Capacity File Format: Adobe Acrobat (PDF) [158k]
Family Home Request to Change Capacity (Spanish) File Format: Adobe Acrobat (PDF) [47k]
Family Home Request to Change Capacity File Format: Microsoft Word (DOC) [228k]
Family Home Request to Change Capacity (Spanish) File Format: Microsoft Word (DOC) [223k]

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