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Child Care Provider Information

The information sheets and forms are Adobe PDF documents or links to the MN Department of Human Services web pages and will open in a separate window.  


Admissions Packet

1.  Emergency Authorization (15 KB) 

2.  Family Day Care Admission and Arrangements (31 KB)

3.  Family and Group Family Day Care Rule Summary For Parents (25 KB)

4.  Immunization Record (181 KB) 
5.  Permission To Administer (12 KB)
6.  Permission To Administer Prescription Medication (14 KB)
7.  Reporting Abuse Policy (133 KB)

Background Check Forms

1. Consent Form (28 KB)

2. Consent Form for New Household Member Ages 13 and Older and Current Household Members Turning Age 13 (20 KB)

3.  Consent Form for Substitutes Helpers and Employees of Child Care Facilities (20 KB)

Change of Premise

1.  Family Child Care Licensing Checklist (91 KB)

2.  Family Systems Application  (120 KB) 

3.  Floor and Escape Plan (257 KB)

General Information & Forms

​1.  Bleach Alternative Checklist (16 KB)

2.  Caregivers - Roles Definitions Training Requirements (135 KB)

3.  Child/Adult Ratios and Age Restrictions (12 KB)

4.  Child Care Licensing Contact Information (13KB)

5.  Crib Inspection Monthly Form (DHS 16_178540)

6.  Emergency Numbers (20 KB)

7.  Family Child Care Liability Insurance Notice to Parents (22 KB)

8.  Fire Drill Log (16 KB)

9.  Food Programs (MN Department of Education)

10. Guidelines for Developing a Provider Policy (25 KB) 

11. Incident Report Form (23 KB)

12. Infant Less Than Six Months of Age Regularly Rolling Over (104 KB)

13. Licensing Fees (46 KB)

14. Parental Consent for Swaddling an Infant (88 KB) 

15. Physician Directive for Infant Sleep Position (41KB)

16. Physician's Report (47 KB)

17. Preschool Programs (12 KB)

18. Training Tracking Info for Child Care Providers and Staff (101 KB)

19. Trampoline Permission Form (20 KB)

20. Variance Request.pdf (152 KB) 

Wading Pools & Swimming Pools
Provider Information:
1.  Statutory Requirements Regarding Wading Pools and Swimming Pools (25 KB)
2.  Family Child Care Best Practices Guide for Wading Pools/Pool Questions and Answers (21 KB)

Parent Information:

1.  Fact Sheet-Risks of Wading Pools at Child Care Homes (18KB)

2.  Fact Sheet-Risks of Swimming Pools at Child Care Homes (24 KB)

3.  Wading Pool Letter and Parent Permission Form (15 KB)

4.  Swimming Pool Letter (14KB)    

5.  Swimming Pool Parent Permission Form (14 KB)    

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Child Care Licensing
Address:
2117 Campus Drive SE
Suite 200
Rochester, MN 55904
Map
Phone:
Email:
Hours:
8 AM - 5 PM
Monday - Friday
Contact Us
Child Care Licensing
Address:
2117 Campus Drive SE
Suite 200
Rochester, MN 55904
Map
Phone:
Email:
Hours:
8 AM - 5 PM
Monday - Friday

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