Family Child Care Forms

Permission Slips:

• Child Care Activity - School Age off-premises Authorization Form
  (School-Age Off Premises and transportation of child care children)
• Medication
  (Permission to Administer Medication)
• Trampoline
  (Permission to use Trampoline)
• Wading Pool
  (Consent to use Wading Pool)

Child Care Program Reporting Notification
(Has information about when your provider must report suspected child abuse and who parents can contact when they have concerns.)

• Summary of Minnesota Rules governing child care

Use the downloadable permission slips to print and give to parents.

Forms parents may need to sign:

• Child Care Immunization Record
  (Form must be completed for each child entering a care program.)
• Child Care Program Reporting Notification
  (Covers child abuse reporting and complaints about a family child care program.)
• Day Care Insurance Coverage Statement
  (Must be signed by parents if provider does not have adequate liability insurance.)
• Family Day Care Admission and Arrangement
  (The initial application form a parent fills out for each child.)
• Swimming Pool Contract
  (Indicates what you have done to make your swimming pool safe and that the parents have read the requirements.)

Variance Requests:

• Age Distribution / Capacity
• Pet

Background Study Notice and Application:

• Initial Application (This form is to be used by persons who have never completed a background study form with Anoka County or have not completed one within the last 12 months.)
• Relicensing (This form is to be used by persons who have completed a background study with Anoka County in the past 12 months.)

Forms providers need to sign and return to Anoka County Child Care Licensing:

• Sudden Infant Death Syndrome Infant Care Agreement
• Sudden Infant Death Syndrome Training Verification

Enrichment Program forms:

• Program Plan/Reimbursement form

Logs and checklists for providers:

• Field Trip Permissions Log
• Fire and Storm Drill Log
• Monthly Crib Safety Inspection form
• Record of Background Study, Training Dates and Substance Abuse Policy
• Swimming Pool Checklist
• Training Log