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  12/2018
  *CCL 801  Application  12/2018
  *CCL 002  Background and Registry Check  12/2018 en EspañolCL 002  03/2017
  CCL 002a DIP Affiliate Roles  05/2019

  Supplemental Forms in the SA/DIP application packet
  CCL 002  Background and Registry Check  12/2018 en EspañolCL 002  03/2017
  CCL 002a DIP Affiliate Roles  05/2019
  CCL 010  Authorization for Emergency Medical Care  07/2015 en EspañolCL 010
  CCL 028  Notification of Injury, Illness, Critical Incident  02/2016 en EspañolCL 028
  CCL 356  Application for Program Director Approval  05/2014
  CCL 357  Health Status for 14 years & Older  01/2014
  CCL 358  Child Health History  01/2014

  Additional forms not in the application packet
  CCL 031  Request for Exception  05/2013
  CCL 032  Request for Amendment  05/2013 en EspañolCL 032
  CCL 360  Inquiry Regarding Licensure: SAP  01/2014

  Informational
  Child Care Initial & Annual Surveys 09/2014 en EspañolSpanish
  Child Care Complaint Survey Information 09/2014 en EspañolChild Care Complaint Survey Information
  CCL 006  Reporting Suspected Abuse/Neglect  07/2015 en EspañolCL 006
  | CCL 008  Licensing of Child Care  09/2014
  CCL 036  Selecting Child Care: Guide for Parents  01/2014