School Age Drop-In Program (SA/DIP)

Forms

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

• *Indicates forms to be submitted to KDHE (Additional documentation is required)

  Instructions for Completing an Application for a SA/DIP  02/2009
  *CCL 801  Application  02/2009
  *CCL 002  Request for KBI/DCF Registry Check  08/2011 en EspañolCL 002

  Supplemental Forms in the SA/DIP application packet
  CCL 002 Request for KBI/DCF Registry Check  08/2011 en EspañolCL 002
  CCL 010  Authorization for Emergency Medical Care  08/2011 en EspañolCL 010
  CCL 028  Notification of Injury, Illness, Critical Incident  08/2011 en EspañolCL 028
  CCL 356  Application for Program Director Approval: SAP  09/2003
  CCL 357  Health Status for 14 years & Older  09/2003
  CCL 358  Child Health History  08/2011

  Additional forms not in the application packet
  CCL 031  Request for Exception  09/2003
  CCL 032  Request for Amendment  09/2003 en EspañolCL 032
  CCL 360  Inquiry Regarding Licensure: SAP  11/2004

  Informational
  Child Care Initial & Annual Surveys 06/2010
  Child Care Complaint Survey Information 11/2010
  CCL 006  Reporting Suspected Abuse/Neglect  02/2010 en EspañolCL 006
  | CCL 008  Licensing of Child Care  08/2011
  CCL 036  Selecting Child Care: Guide for Parents  03/2010