Day Care Forms
New! Pay Relicensing Fee with a Credit Card!
Required Forms, One for Each Family
- Mandated Reporter Policy (Maltreatment Reporting) - Reporting suspected child abuse or neglect
- Provider Policies (PDF): - sample provider policies to be discussed with parents (you must write your own).
- Child Care Emergency Plan (EPP) - New EPP includes infant/toddler plan OR you can add the addendum below to an existing EPP:
- Infant Toddler EPP Addendum
- Keeping Kids Safe Not required for each family, just useful for completing the Emergency Plan
- Your Child’s Safety in Licensed Family Child Care (PDF) - Rules of family and group day care given to parents
Required Forms for Every Child
- Family Child Care Admission and Arrangements - Information sheet on family and child
- Child Care Immunization Record (PDF) - Record your child’s immunizations or exemptions on this form for your child care provider.
- Permission to Administer - Prescription and Non-prescription (PDF) - To be signed by parent for provider to use non-prescription items
Forms That May Be Required
- Insurance Statement (PDF) - Notification to parents of provider’s liability insurance status (may be required annually - see form for details)
- Physician Directive for Alternate Sleep Position - To be used when a physician orders an infant sleep position different from on the infant’s back
- Swaddling Consent - To be used when a parent consents to swaddling an infant who has not yet rolled over
- Acknowledgement of Infant Independently Rolling Over (PDF) - To be used when an infant under 6 months of age rolls over
- Allergy Information Form (PDF) - To be used when a child in care has an allergy
- Smoking Sign (PDF) - Must be posted near the daycare entrance if anyone in your household smokes in the house or attached garage during non-business hours.
- Swimming Pool Consent Form (PDF) / Regulations (PDF) - Permission by parent for a provider to use a swimming pool
- Wading Pool Consent Form (PDF) / Regulations (PDF) - Permission by parent for a provider to use a wading pool
Non-Required but Recommended Forms
- Family Day Care Supplemental Form (PDF) - Non-required form for parents to use when describing their child to the provider
- Trampoline Consent Form (PDF) - Permission slip to be signed by parent for a provider to use a trampoline
Logs, Checklists, Annual Tasks
- Family Day Care Floor and Escape Plan (PDF)
- Training Log for Relicensure (PDF)
- Monthly Fire and Storm Drill Log (PDF)
- Update and Summary of Children in Daycare (PDF)
- Monthly Crib Safety Inspection Form
- Child Records (Enrollment Forms) Checklist (PDF)
- Substitute Tracking Hours
- Well water test kit from Zoning Department
- Fire Extinguisher Servicing Agencies (PDF)
- Child Care Paperwork Cheat Sheet for Renewal and Updates (PDF)
- Full Family Childcare Licensing Checklist
Forms Providers Need to Sign and Return to Sherburne County
- Background Study Data Collection Form
- Complete pages 1 and 2 and sign page 2
- Make a copy of your identification (driver’s license, state ID, passport, or school ID if none of these apply)
- Mail the completed form with the identification copy to SCHHS, Alecia Hinton, 13880 Business Center Drive NW, Elk River, MN 55330
- Variance Requests
- Physician's Report