Forms
Licensed centers
- Application for child care center variance or waiver
- Application for construction permit for child care facility - state form 49454
- Attestation
- Breast milk procedure - state form 49954
- Business permit
- Child care medical waiver - state form 56619
- Center Child File Resource Sheet
- Center Staff File Resource Sheet
- Child staff ratios for licensed child care centers - state form 55571
- Cleaning schedule - state form 49959
- Consent to release information for licensed centers, licensed homes, unlicensed registered ministries and CCDF LLEPs - state form 53323
- Drug Testing Guidelines
- Employee verification for universal precautions
- Food serving sizes - state form 49956
- Health and safety new employee orientation training verification
- Health care program for child care centers - Child care center health record - state form 49969
- Health care program for child care centers - Procedure for skin care - diapering - state form 49971
- Health care program for child care centers - Record of adult physical health examination group homes / institutions - state form 49970
- Healthcare program for child care centers - state form 45877
- History of Immunizations - state form 49445
- Immunization charts
- Indiana Child Care and Development Fund Drug - Substance Abuse Screening Test Consent Form
- Injury report form for licensed child care centers - state form 54265
- Licensed child care center / home consent - state form 50548
- Manual utensil and equipment washing - state form 49958
- Menu for infants (8-12 months) - state form 49951
- Menu for toddlers - state form 49952 (2-year-olds and older)
- Menu pattern - state form 49957
- Menu planner - Child care center - state form 49955
- Monthly report of licensed child care centers and homes (as required by IC 12.17.2-2-1.5) - state form 46789
- Pre-licensing child care center - state form 49450
- Proof of local business permit / license to operate a child care program - state form 56523
- Proposed child care center review - state form 52087
- Provider response form - state form 53320
- Record of medication order - state form 49968
- Review / assessment for child care centers - state form 46153
- Safe transportation of food responsibility agreement
- Sample intake agreement form
- Sample menu for infants (8-12 months) - state form 49950
- Sample new employee orientation form
- Sanitation / sterilization procedures for bottles, nipples, collars, caps - state form 49953
- Sanitizing solutions - state form 49973
- Supplement to health program form - infant / toddler - state form 45878
- Suggested infant-toddler feeding plan - state form 49963
- Infant-toddler weekly record of daily needs - state form 49960
- Request for taxpayer identification number and certification (W-9)
- Training record log
- Tuberculosis questionnaire
- Verification and documentation of universal precautions training form
- Written nutrition food service program for child care centers - state form 46684
- Written nutrition food service program infant/toddler child care centers - state form 46682
- W-9 form
Licensed homes
- Application for child care home variance or waiver - state form 48269
- Attestation - state form 48629
- Breast milk procedure - state form 49954
- Business permit
- Child care home certification of residential structure - state form 51447
- Child care home injury report (medical attention needed) - state form 54265
- Child care home licensing report - state form 46739
- Child care medical waiver - state form 56619
- Child/staff ratio chart for licensed home and PES
- Consent to release information for licensed centers, licensed homes, unlicensed registered ministries and CCDF LLEPs - state form 53323
- Drug Testing Guidelines
- Employee verification for universal precautions
- Health care program for child care centers - Record of adult physical health examination group homes / institutions - state form 49970
- Health and safety new employee orientation training verification
- Health program for accredited child care homes
- History of immunizations - state form 49445
- Home Child File Resource Sheet
- Home Staff File Resource Sheet
- Immunization charts
- Indiana Child Care and Development Fund Drug - Substance Abuse Screening Test Consent Form
- Licensed child care center / home consent - state form 50548
- Monthly report of licensed child care centers and homes (as required by IC 12-17.2-2-1.5) - state form 46789
- PTQ voluntary decline form
- Proof of local business permit / license to operate a child care program - state form 56523
- Proposed class II child care home design professional statement - state form 53939
- Proposed multiple residences for child care home design professional statement - state form 51476
- Provider response form - state form 53320
- Request for taxpayer identification number and certification (W-9)
- Sanitizing solutions - state form 49973
- Tuberculosis questionnaire
- Verification and documentation of universal precautions training form
- W-9 form
Registered ministries
- Application for voluntary certification program variance/waiver
- Attestation - state form 48629
- Breast milk procedure - state form 49954
- Checklist for registered child care ministries sanitation survey - state form 49441
- Child care development fund provider eligibility standards checklist - state form 51363
- Child care medical waiver - state form 56619
- Consent to release information for licensed centers, licensed homes, unlicensed registered ministries and CCDF LLEPs - state form 53323
- Employee verification for universal precautions
- Health and safety new employee orientation training verification
- History of immunizations - state form 49445
- Immunization charts
- Ministry Child File Resource Sheet
- Ministry Staff File Resource Sheet
- PTQ voluntary decline form
- Parent's notice - state form 49444
- Provider response form - state form 53320
- Safe transportation of food responsibility agreement
- Sample discipline policy
- Sanitation/sterilization procedures for bottles, nipples, collars, caps - state form 49953
- Sanitizing solutions - state form 49973
- Verification and documentation of universal precautions training form
- Voluntary certificate program checklist - state form 49443
- W-9 form
- Injury report form
Legally licensed-exempt providers
- Attestation statement - state form 48629
- Child care and development fund drug testing guidelines
- Child care development fund provider eligibility standards checklist - state form 51363
- Child care licensing exemption affidavit - state form 56872
- Child care medical waiver - state form 56619
- Child/staff ratios for licensed centers and unlicensed CCDF providers with more than 16 children enrolled
- Cleaning schedule - state form 49959
- Consent to release information for licensed centers, licensed homes, unlicensed registered ministries and CCDF LLEPs - state form 53323
- Drug test consent form
- Drug Testing Guidelines
- Drug testing policy
- Employee verification of UP training
- Evacuation plan in case of fire or other emergency
- Fill-in skin care - diapering - state form 49971
- Food serving sizes - state form 49956
- Health and safety new employee orientation training verification
- History of immunizations - state form 49445
- Immunization charts
- Indiana Child Care and Development Fund Drug - Substance Abuse Screening Test Consent Form
- Injury report form
- LLEP (Exempt) Child File Resource Sheet
- LLEP (Exempt) Staff File Resource Sheet
- Menu for infants - state form 49951
- Menu for toddlers - state form 49952
- Menu pattern - state form 49957
- Menu planner - state form 49955
- Monthly fire drill log
- Nutrition resources
- Personnel file review worksheet
- Proof of local business permit / license to operate a child care program - state form 56523
- Record of medication order - state form 49968
- Report child abuse book mark
- Sample child file worksheet
- Sample cleaning and sanitation process
- Sample discipline policy
- Sample emergency staff plan
- Sample medication administration form
- Sample menu for infants - state form 49950
- Sample orientation form
- Sample safe conditions policy
- Sample supplemental criminal history reporting
- Sample tobacco and substance policy child care and development fund program
- Sample transportation policy
- Sample written plan in case of an illness, death or injury
- Sanitization/Sterilization procedures - state form 49953
- Sanitizing solutions - state form 49973
- Supplemental health care program - state form 49961
- Suspension and expulsion policy
- Transportation form
- Tuberculosis questionnaire
- Tuberculosis questionnaire
- W-9 form