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• Note - Forms for parents to complete are indicated in red.

• *Indicates forms to be submitted to KDHE

  Instructions for Completing CCL 201  07/2010
  *CCL 201 Application  07/2010 en EspañolCL 201
  *CCL 002  Request for KBI/SRS Registry Check  02/2010 en EspañolCL 002
  *Fire/Life Safety Agreement (located at www.ksfm.ks.gov)

Portfolio Supplemental Forms in the LDCH/GDCH application packet

• Supplemental Forms for the LDCH/GDCH
  CCL 005  Yearly Mechanical Safety Check  02/2010 en EspañolCL 005
  CCL 009  Health Assessment, 16 & Older  02/2010 en EspañolCL 009
  CCL 010  Authorization for Emergency Medical Care  02/2010 en EspañolCL 010
  CCL 026  Short-Term Medication Authorization  02/2010 en EspañolCL 026
  CCL 027  Long-Term Medication Authorization  02/2010 en EspañolCL 027
  CCL 028  Notification of Injury, Illness, Critical Incident  02/2010
  CCL 029 & 029a  Child Medical Record, Immunization History, & Health Assessment  02/2009
  CCL 034  Parental Permission, Off-Premise Trips  07/2010 en EspañolCL 034
  CCL 035  Parental Permission, Off-Premise, Group Trips  07/2010 en EspañolCL 035
  CCL 204  Provider’s Self-Evaluation Checklist  09/2003
  CCL 206  Report of Directed Readings  09/2003
  CCL 207  Record of Observations  09/2003

  Additional forms not in the application packet
  CCL 031  Request for Exception  09/2003
  CCL 032  Request for Amendment  08/2010 en EspañolCL 032
  CCL 205  Schedule of Enrollment  09/2003

  Informational
  Child Care Initial & Annual Surveys 06/2010
  CCL 006  Reporting Suspected Abuse/Neglect  02/2010 en EspañolCL 006
  CCL 008  Licensing & Registration of Child Care  09/2007 en EspañolCL 008
  CCL 011  Recommended Health Supervision  12/2008
  CCL 012  Behavior and Guidance  02/2010 en EspañolCL 012
  CCL 025  Diapering of Children in Child Care  09/2003
  CCL 033  Comparing RDCH, LDCH, & GDCH  02/2010 en EspañolCL 033
  CCL 036  Selecting Child Care: Guide for Parents  03/2010
  CCL 037  Guidelines for Exclusion  02/2010 en EspañolCL 037
  CCL 208  Guidelines for Training: LDCH/GDCH  02/10