Forms & Resources for Daycare Providers

Daycare Children File Forms

• Checklist for Children's Record (PDF)
• Permission to Administer Form (PDF)
• Family Child Care Admission & Arrangements DHS-7776
• Immunization Record Form (PDF)
• Liability Insurance Notice to Parents or Guardians DHS-7741 (PDF)
• Family Child Care Allergy Information Form DHS-7736 
• Family Day Care Supplemental Form (PDF)
• Wading Pool
  • Parent Letter
  • Best Practices
  • Wading/Swimming Pool Consent Form DHS-7749C
• Transportation/Field Trip Authorization Form (PDF)
• Day Care Accident/Incident Report Form (PDF)
• Physician Directive for the Alternative Infant Sleep Position DHS-7634C (must provide copy to parent)
• Swaddling Consent for an Infant DHS-7219
• Infant Rolling Over Parent Statement DHS-7219
• Maltreatment of Minors Mandated Reporting DHS-7634C (must provide copy to parent)

Enrollment & Miscellaneous Forms

• Monthly Crib Safety Inspection Form DHS-7743
• Benton County Fence Guidelines (PDF)
• Fire and Storm Drill Log (PDF)
• Emergency Preparedness Plan DHS-7414C
• Emergency Preparedness Plan Addendum DHS-7955

Background Studies

• Family Child Care Data Collection Form (PDF)
• Background Study Notice of Privacy Practices (PDF)

Additional Resources & Information

• Training Requirements for Licensed Family Child Care DHS-7672
• Child Care Assistance Plan (PDF)
• Age Group Definitions-Day Care Capacity (PDF)
• Helping Your Family Adjust to Child Care (PDF)
• Local Fire Marshal Inspectors/Guidelines (PDF)
• Fire Marshal Day Care Information Sheet (PDF)
• Provider Policies - Required Items (PDF)
• Sample Day Care Contract (PDF)
• Keeping Kids Safe DHS-7414
• Develop-MN Quality Improvement & Registry Tool
• Center for Inclusive Child Care
• Hennepin County Infectious Disease Manual

Variance request Packet

• Variance Policy- for your information (PDF) 
• Variance Request Form: Child Care (must complete)
• Child Care Weekly Attendance Schedule (must complete for capacity variance)
• Variance Request Notice for Parents (must complete for capacity variance)
• Variance Calendars (optional)

Rules & Statutes

• Rule and Statute Summary DHS-7747
• Minnesota Administrative Rules - Chapter 9502
• Minnesota Statutes 2020 (PDF)

Mandated Reporting

• Resource Guide for Mandated Reporters DHS-2917
• Reporting Policy for Benton County (PDF)
• Suspected Maltreatment Report Form (PDF)