Department of Children, Youth & Families

Number Sort descending	Form Name	Revision Date	File Format
15-860	Medication Permission Form For Illness and Allergies (FFN)		English (Word) Somali (fillable PDF) Spanish (fillable PDF)
15-861	Initial Checklist for Child Care Center Applicant	05-2023	English (Word)
15-862	Initial Checklist for Family Home Child Care Applicant	05-2023	English (Word) Spanish (Word) Spanish (PDF) Ukrainian (PDF)
15-863	Initial Checklist for School-Age Program Applicant	05-2023	English (Word)
15-867	Tribal Certification-Subsidy Verification	03-2026	English (PDF)
15-874	License Change Plan	10-2025	English (PDF)
15-879	Child Care Registration (fh/ctr)	06-2021	English (Word) English (PDF) Somali (PDF) Spanish (PDF) Ukrainian (PDF)
15-889	Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program		English (Word) English (PDF)
15-891	Chimney, Fireplace, Woodstove Use Statement	09-2019	English (Word) English (PDF) Somali (PDF) Spanish (PDF) Ukrainian (PDF)
15-892	Fire, Safety, Emergency Drills Record	08-2019	English (Word) Amharic (PDF) Somali (PDF) Spanish (PDF)
15-893	Multiple Licenses Request Form		English (Word)
15-894	Family Home Child Care Liability Insurance Form		Engllish (Word) English (PDF) Somali (PDF) Spanish PDF)
15-895	Overnight Child Care Planning Guide		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-896	Probation Notification Letter to Parents from Provider		English (Word)
15-897	Child Care Parent Guardian Permissions		English (Word) English (PDF) Somali (Word) Spanish (Word)
15-899	Child Licensee or Assistant Resume		English (Word) English PDF) Somali (PDF)
15-907	Child Care Violation Dispute Request	08-2019	English (Word)
15-937	Child Care Center School-Age Background Checklist	10-2025	English (PDF)
15-941	Child Care Injury Incident Report		Engllish (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Spanish (Word)
15-942	Daily Child Attendance Records		English (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF)
15-943	Child Care Agreement		English (Word) Spanish (Word)
15-944	School Based and Military Certification for Payment Only Request		English (Word)
15-949	Family Home Child Care Resident and Staff Background Checklist	05-2026	English (PDF)
15-952	Notification to Parents and Guardian - Safe Sleep Non-Compliance		English (PDF) Somali (PDF) Spanish (PDF)
15-954	Notification of Staffing Plan Absence		English (Word) Somali (PDF) Spanish (PDF)
15-955	Family Home and Center Child Care License or Certification Application	01-2024	English (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF)
15-956	No Social Security Card Declaration		English (Word) Somali (PDF) Spanish (PDF)
15-957	Child Care Variance Request		English (Word)
15-961	Child Care Waiver Request		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-963	Early Learning-Child Care Facility Feasibility Checklist		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)