Child Care Providers. MN Department of Human Services Child Care Licensing Forms. Background Check Permission form This form must be filled out for anyone 1. A 2. 5 fee up to 1. Capacity Graph This graph outlines capacity limits for family and group family child care licenses. Immunization Form A form for parents of children to complete before admission into the program. This form is kept on file at the family day care home. Form contains current immunization information for each child. Immunization information must be on file before a child attends child care. Information Sheet This fire safety information sheet is based upon the 2. Minnesota State Fire Code MSFC, 2. Minnesota State Building Code MSBC and the 2. International Residential Code IRC. The requirements outlined in this information sheet apply to Group R 3 One and Two Family Dwellings used for licensed child care. The information covers Exits, Approved Escape Windows, Window Wells, Stairs and Protection of Openings, Smoke Alarms, Fire Extinguishers, etc. Insurance Coverage Statement  The Minnesota Rule governing family child care indicates that A provider shall have a certificate of insurance for the residence for general liability coverage for bodily injury in the amount of at least 1. Child Care Policy SAMPLEDaily Attendance Record  This form is used to track childrens attendance dates and times. Family Child Care Licensing Checklist State of Minnesota Department of Human Services DHS Division of Licensing Family Systems Family Child Care Licensing Checklist MN Rules, Part 9. Family Child Care Variance Brochure These are some important guidelines licensing staff will use when evaluating a request for a variance submitted by a license holder. Family Child Care Variance Request This is the form licensed providers can use to submit a request for a variance of the licensing rule. Family Day Care Admissions and Arrangements A form for parents of children in licensed family day care to complete before admission into the program. The form is kept on file at the family day care home. Licensing protects the health. The Minnesota Department of Human Services. Family child care licensing information for current. Minneapolis MN 55402. Background checks done by Hennepin County Child Care Licensing Home visit by a. This form contains information a provider would need in case of an emergency. Family Day Care Provider Training Record This form summarizes training requirements and provides a place for providers to list the training they have attended. Family Systems Application The Family Systems Application Form is an application form for a license to provide family day care, adult foster care, family adult day services and for adult foster care alternate overnight supervision technology. Fire Storm Drill Record form  Use this form to record your Annual Fire and Storm Drills. Floor and Escape Plan A form for providers of licensed family child care providers to draw a floor plan of their home and designate emergency information. Freedom to Breathe in Family Day Care How Minnesotas Freedom to Breathe Provisions apply to Family Home and Group Family Day Care Providers. Monthly Crib Inspection Safety Form This form is to be used by licensed child care providers for monthly crib inspections and yearly recall checks. Parental Consent for Swaddling an Infant This form is written consent from the childs parents for swaddling the child. Placing a swaddled infant to sleep in a licensed setting is NOT recommended for an infant of any age and is otherwise prohibited for any infant who has begun to roll over independently. Install Imagemagick On Windows Xampp Installer. Permission to Administer Over the Counter Medications Permission to Administer Prescription Medications Physician Directive for Alternative Infant Sleep Position The licensed provider must place infants on hisher back for sleep unless the provider has a signed directive from a physician for an alternate sleep position. This form is the approved format to direct an alternative sleep position and must remain on file at the licensed location. This form must be signed by the childs physician. Washington County Mn Daycare LicensingRequest for Fire Inspection This form is used by family day care, group family day care, child foster care and child care center providers licensed by the Minnesota Department of Human Services DHS to request a fire inspection from the State Fire Marshals Office andor your local fire department. Safe Infant Sleep in Child Care A Sample Policy for use in Child Care. Wading Pool Fact Sheet Risks of Wading Pools at Child Care homes. Wading Pool Permission form A letter form from the Minnesota Department of Human Services DHS and the Minnesota Department of Health MDH to parents of children in licensed child care asking them to grant or deny permission for their childchildren to use a wading pool. Weather Watch Useful information about Heat Index Wind Chill. Contact information childcarestlouiscountymn.