Licensed and Group Day Care

(LDCH/GDCH) Forms

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

• *Indicates forms to be submitted to KDHE

  Guidance for New Child Care Providers | 02/2012
  Instructions for Completing CCL 201  09/2012
  *CCL 201 Application  07/2010 en EspañolCL 201
  *CCL 002  Request for KBI/DCF Registry Check  08/2011 en EspañolCL 002
  *Fire/Life Safety Agreement (located at www.ksfm.ks.gov)

• Supplemental Forms for the LDCH/GDCH
  CCL 005  Yearly Mechanical Safety Check  08/2011 en EspañolCL 005
  CCL 009  Health Assessment, 16 & Older  08/2011 en EspañolCL 009
  CCL 010  Authorization for Emergency Medical Care  08/2011 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  08/2011
  CCL 029 & 029a  Child Medical Record, Immunization History, & Health Assessment  08/2011
  CCL 034  Parental Permission, Off-Premise Trips  08/2011 en EspañolCL 034
  CCL 035  Parental Permission, Off-Premise, Group Trips  08/2011 en EspañolCL 035
  CCL 204  Provider’s Self-Evaluation Checklist LDCH  02/2012
  CCL 204a Provider's Self-Evaluation Checklist GDCH 02/2012
  CCL 207  Record of Observations  08/2011
  2012-2013 School & Child Care Immunization Information

  Additional forms not in the application packet
  CCL 031  Request for Exception  09/2003
  CCL 039 Request for Family Foster Home Exception
  | CCL 032  Request for Amendment  08/2010 en EspañolCL 032
  CCL 205  Schedule of Enrollment  08/2011

  Informational
  Child Care Initial & Annual Surveys 06/2010
  Child Care Complaint Survey Information 11/2010
  Provider Guidance for Family Foster Home Exceptions |
  CCL 006  Reporting Suspected Abuse/Neglect  02/2010 en EspañolCL 006
  CCL 008  Licensing of Child Care  08/2011
  CCL 011  Recommended Health Supervision  12/2008
  CCL 012  Behavior and Guidance  08/2011 en EspañolCL 012
  CCL 025  Diapering of Children in Child Care  08/2011
  CCL 033 Comparing Licensed Day Care Homes  02/2010
  CCL 036  Selecting Child Care: Guide for Parents  03/2010
  CCL 037  Guidelines for Exclusion  08/2011 en EspañolCL 037
  CCL 208  Guidelines for Training: LDCH/GDCH  02/2012
  SIDS Child Care Safe Sleep (.pdf)