Forms for Providers
- Background Study Documentation: This form is required for a provider to document when a background study is initiated and when it is completed.
- Chemical Usage Policy: Required policy for all family child care programs and signed by all caregivers / employees.
- Enrollment Form: Use to submit monthly enrollment changes to licensing.
- Family Child Care Orientation Forms: Forms required for a Family Child Care Application.
- Family Child Care Relicensing Forms: Forms a provider is required to complete and submit to Chisago County for family child care relicensing purposes.
- Incident Report Form: For documentation of any injury that occurs in the child care home.
- Monthly Crib Safety Inspection Form: Used to document monthly and annual verification that cribs are safe.
- Monthly Fire / Storm Drill Log: For documentation of required monthly fire / storm drills.
- Parental Acknowledgement that Infant is Rolling Over: Signed statement from parent when an infant under the age of 6 months is regularly rolling over after being placed to sleep on his/her back.
- Parental Consent for Swaddling an Infant: This form is required if a parent wants the provider to use a swaddle such as a sleep sack. Swaddle is defined on the form.
- Physician Directive for Alternative Infant Sleep Position: Required if a parent wants their infant child to sleep in a position other than on their back to sleep.
- Release of Information: Background study release of information.
- Variance Request: Used with enrollment form to request a variance to age distributions and/or capacity.
- Child Care Emergency Plan template: DHS template for required Emergency Plan
- Keeping Kids Safe - Child Care Planning Guide: DHS Child Care Planning Guide to use in completing the Child Care Emergency Plan
Forms for Parents
- Admission and Arrangements: Parental permission to enroll child in providers child care.
- Allergy Information Form: Parents complete one form for each child with a known allergy.
- Immunization Record: Used to keep a current list of child's immunizations.
- Mandated Reporter Notification: Policies and procedures provided to parents at time of enrollment regarding child abuse and neglect reporting.
- Permission to Administer Prescription Medication: Parental permission allowing provider to administer prescription medications.
- Permission to Administer: Parental permission to administer over-the-counter medication / products (1 form per child).
- Permission to Leave Premises: Parental permission for child to leave providers' premises.
- Wading Pool Permission: Families to complete 1 form per child to allow them to use the provider's wading pool.
- Rule Summary for Parents: A summary of Rule 9502 (Rule 2) to be given to parents at enrollment
- Family Child Care Liability Insurance Notice to Parents / Guardians: Used to notify families enrolled in the family child care that the provider has insurance, when the policy is renewed or lapsed, any change in status of the insurance, and the annual notification of no insurance