Forms for Child Care

Background Studies

• Background Study Documentation Form-72000-113 8/10 (PDF)

Class Worksheets

• Class A License Worksheet-72000-129 A 9/14 (PDF)
• Class C-1 License Worksheet-72000-129 C-1 9/14 (PDF)
• Class C-2 License Worksheet-72000-129 C-2 9/14 (PDF)
• Class C-3 License Worksheet-72000-129 C-3 9/14 (PDF)

Emergency/Safety

• Emergency Preparedness Plan-DHS-7955 (PDF)
• Fire Extinguisher List-72000-7 3/22 (PDF) (must be tagged annually)
• Guidance:  Poisonous Plants in Family Child Care-DHS-7745 (PDF)
• Monthly Crib Safety Inspection Form-DHS-7743 (PDF)
• Monthly Drill Log - Child Care Homes-72000-63 11/19 (PDF)
• Serious Injury Reporting Form - Family Child Care-DHS-7774 (PDF)

Miscellaneous

• Certificate of Compliance-MN Workers’ Compensation (PDF)
• Child Care Assistance Provider Form-EA-572 6/15 (PDF)
• Child Enrollment-Family Child Care-DHS-7934 (PDF)
• Electronic Data Consent-70000-21 9/20 (PDF)
• Family Child Care Request for Expedited Correction Order Reconsideration-DHS-TCM-1053-327240 (PDF)
• Family Child Care Weekly Attendance Schedule-DHS-7297A (PDF)
• Licensing Requirement Dispute - Family Child Care-DHS-7966 (PDF)
• Licensing Requirements - Family Child Care-DHS-7775 (PDF)
• Physician’s Report-DHS-1995 (PDF)
• Provider Training Record-CC-72000-27 4/21 (PDF)
• Substitute Tracking-Child Care Licensing-72000-153 11/19 (PDF)

Variances

• Variance Request-Family Child Care-DHS-7297 (PDF)
• Variance Request Form - Extended Use of Substitutes - Family Child Care-DHS-7964 (PDF)
• Variance Request-Notice for Parents-DHS-7297B (PDF)