I recommended that Ms. DuBois create a form for each staff members file or have each complete the relevant sections of a child information card. If you need help with the databases or have questions about your child care search, please email or leave a voicemail at (734) 763-9379 for prompt assistance. Box 30664 Lansing, MI 48909-88164 before submitting the form to your (or your assistant caregivers) physician. Forms for private child placement agencies. 2-2020 and Rev. Statement6. Ms. DuBois did not maintain the names, addresses, and telephone numbers for each child care staff member. The bureau program is designed to protect the health, safety and welfare of children receiving care and services in licensed child care settings. Licensed Child Welfare Facilities include: Child Caring Institutions, Child Placing Agencies and Court Operated Facilities. CCL-3900 (Rev. Enrollment forms should include the names and contact information of parents, along with emergency contacts and information about other parties authorized to drop off or pick up. 2-2021 may be used. Annual Evaluation7 You may copy this form if you need additional sheets. TTY/TDD users can call the Minnesota Relay at 711 or (800) 627-3529. Child Care Licensing Access Fairs. Zoning Approval for Group Child Care Homes (BCAL-3748). Parents Deal with Lesser Stress. to review under the Statewide Search for Licensed Child Care Centers and Homes. 2. R 400.8143 Children's records. Click on the name of the facility for more detailed information including online inspection reports completed on or after July 1, 2002. child enrolled and each employee for at least 2 years after the individual leaves the center. Any individual who is employed by a child care provider and any individual who may have unsupervised access to children in care should have a comprehensive criminal background check. This form is available for download in PDF, ODT, and Word formats. Step 3. 5/19) Page 4 of 5 LARA is an equal opportunity employer/program. An assistant caregiver may care for your child in my absence. Rules The emanuals websitecontains all rules, forms, procedure and manual letters. MAIL COMPLETED FORM TO: Michigan Department of Licensing and Regulatory Affairs Child Care Licensing Bureau P O Box 30664 Lansing, MI 48909 Licensing Consultant (if known): LICENSEE/APPLICANT NAME County LICENSE NUMBER (If assigned) [R 400. Eligibility Date4. Licensing and Regulatory Affairs - Provider Resources Information on Training, Rules & Statutes, Technical Assistance, Forms, Safety, Resources, and more. Due to the Memorial Day Holiday, payments that would normally be issued on Thursday, 6/2/2022, will be issued on Friday, 6/3/2022 instead. Also see Important Notice below regarding reimbursement from MDHHS. [R 400.1906(3)] There are animals and pets in the child care home. CHILD IN CARE STATEMENT/RECEIPT [R.400.1907(b)] State of Michigan Department of Licensing and Regulatory Affairs Child Care Licensing Bureau Licensee Name Child(ren)s Name(s) (Last, First, Middle Initial) Forms & Publications; Online Services; Regulatory Compliance Division; Testing & Education; Child Care Licensing Quick Links. Box 30664 Lansing, MI 48909-8164 Or email to BCALLicensingUnit@michigan.gov Safety of the building (such as emergency exits, cleanliness and repairs, and potential dangers) LeBrun, and child care staff members Danielle Heinritz, Bridget Cinas, and Martaysia Brown from 10:00am until 11:00am. Consent and Disclosure Form Completion Date4. The Child Care Licensing Bureau performs state licensing regulatory duties as required by state laws and federal requirements. A copy of this form must be provided to parents. Your local zoning authority If you need help writing the corrective action plan, please contact me. CHILD IN CARE STATEMENT/RECEIPT Child(ren)'s Name(s) All child care programs in our state are required to be licensed, registered, approved, or legally exempt. 5-2021) Previous editions BCAL -3900 Rev. CHILD CARE FAMILY/GROUP HOME RENEWAL APPLICATION PROCESS I. Childcare Emergency Services Registration Form 43. Sample Registration Form for Childcare 44. School Age Childcare Registration Form 45. Sample Day Care Registration Form 46. Extended Childcare Registration Form (1) At the time of a child's initial attendance, a center shall obtain a child information card, using a form provided by the department or a comparable substitute, that is completed and signed by the child's parent. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. I certify that I accurately completed this form and if anything changes, I will I will inform you before each occurrence. The Guidance for Part 4 Individual Rights a. I understand that upon my written request, the department will provide a copy of any disqualifying record The center shall keep it on file and accessible in the center. Begin by recording the date when the child is to arrive. Signed. When using the forms, write the children's name in the spaces provided on the left side of the form. [R 400.1906(3)] There are animals and pets in the child care home. I give permission to _____, licensed by the Department of Licensing and Regulatory Affairs to secure emergency medical treatment for the above named minor child while in care. Download the file in your preferred format before proceeding onto the steps below. - This form shall not be completed for Child Care Staff or Volunteers. You can learn more about your states criminal background check requirements by contacting your state licensing agency. Below are forms and documents for your inspections. Be sure to get your application in before the grant closes. How to Make Professional Childcare Registration Forms. Department of Commerce (19651996) Supplemental Information Form (BCAL-3737). Forms listed are in the portable document format (PDF). Forms for child care centers are now located on the updated Licensed Child Care Centers web page. 651-431-6500. Step 2. You can use the sample forms as they are or change them to meet your needs. The Access Fairs bring together all the essential elements of licensing into one space with the overall goal to increase the number of licensed child care facilities across the state. This responsibility includes developing minimum requirements for child care programs, revising existing requirements, and implementing policies and procedures for the licensing program. For answers to questions about the Child Development and Care program, including topics such as enrollment, billing, and important updates, please visit our website at www.michigan.gov/childcare 1903 (1d)] All children who reside in the child care home have been immunized as recommended by the Department of Community Health. BOX 30664 LANSING, MICHIGAN 48909 use our corrective action plan form or create your own. NAME OF FORM FORM # QUANTITY . 1. 3. [R 400. I will inform you before each occurrence. DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING ORLENE HAWKS DIRECTOR 611 W. OTTAWA P.O. 17. name and facility number of other community care, child care, residential care facilities for the elderly, or health facilities licensed to or owned by applicant(s) within the last five years; if yes, facility name and number: licensing agency name: lic 200a (6/08) page 1 of 2 16. source of water for human consumption public private After reviewing the help guides, if you have any questions, please contact us at APPLICATION Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems P.O. The following is information regarding application for a child care center. CCL-3900 (Rev. Author: Case-French, Candice (LARA) Created Date: 07/27/2021 11:15:00 Title: Center Fire and Tornado Drill Record Professional Services Get Offered. Highlights of the rule changes that apply to both family and group child care homes and child care centers: The rule changes for Child Care Centers took effect on December 18, 2019. Fillable and printable Child Care Enrollment Form 2022. ALLEGATION: The complainant drove by the child care to see if the child care was open and noticed a green bucket infant swing hanging from a tree, very high up. TB Test5. We provide a warm, safe, entertaining, and developing care Monday through Friday, 7:30 AM to 5:30 PM, and may have special hours during holidays. If you change any of the sample forms, be sure they still contain all information required by rule. Help guides on how to set up an account, link a license, apply for a new license, or renew a license can be found under each of the separate profession links. 12/29/2021 Exit conference Exit conference with Kimberly Vaughn. DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING ORLENE HAWKS DIRECTOR 611 W. OTTAWA P.O. Currently the daycare capacity is 8 children. Name of Provider/Facility: LARA is an equal opportunity employer/program. No need to create forms simply choose the forms that you feel are best for your daycare then click, print and use! Attendance forms are the easiest way to keep track of exactly how many hours each of the children are in your care. To apply for a new license or renew a license, use the applicable applications below. Explore Different Templates to Adjust Later. The Oklahoma Child Care Facilities Licensing Act (10 O.S., 401-410), enacted in 1963, authorizes OKDHS to administer the licensing program. Abuse/ Neglect. 611 W. OTTAWA P.O. 2-2021 may be used. Step 1. Step 1 Download the Form. This message area was updated Tuesday, May 17, 2022. Forms Request CDC revised 216 / LARA is an equal 1903 (1d)] All children who reside in the child care home have been immunized as recommended by the Michigan Department of Health and Human Services. [R 400.1936 (1)] If yes, list: Click on the chapter name to go directly to the following rules. A copy of this form must be provided to parents. Child Care Application (BCAL-3970). Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems P.O. While basic information is updated by the State of Michigan, you will need to inquire with specific child care programs regarding current and upcoming openings, rates, hours, etc. New Enrollment Form (One per family) Child Information Form (One per Child) Parent Agreement (One per Family) DHS Parent Agreement (only if using OKDHS EBT card) Visit. 517-335-9855. 1The following individuals must have an orientation: licensees, licensee designees, child care staff members, child care aides. Application for license DHS-7118 (PDF) For more information about licensing forms, call (651) 431-6500; or fax to (651) 431-7643. I conducted a special investigation because the child care licensing division received a use our corrective action plan form or create your own. Additional forms may be presented and/or required at the time of enrollment. Resources for Veterans. Approval for a special use permit or other similar permit to run a group child care home must be obtained from your city or township, per the Michigan Zoning Enabling Act, 2006 PA 110. Date Printed4. Chapter 5101:2-12 Child Care Centers Chapter 5101:2-13 Child Care Type A Homes Chapter 5101:2-14 Child Care Type B Home 9/14/2021) Previous editions BCAL -3900 Rev. Reducing Barriers to Licensure for Military Families Child care licensing regulations cover many topics, including the following: The number of children one adult can care for a time (child-staff ratio) and the number of children allowed in a class (group size) Supervision of children. Spring 2022 Grants: The Spring 2022 grant application will close at 6:00 p.m. on Thursday, May 26th. Make sure the form is located in an area where parents have easy access. BCHS-WBC-4001 (Rev. Learn more EBU Paperwork - MSU Student Parent Resource Center. Print and read the Licensing Rules for Family and Group Child Care Homes or the Licensing Rules for Child Care Centers and 1973 PA 116 prior to submitting your application. Fill, sign and download Child Care Enrollment Form online on Handypdf.com 2-2020 and Rev. Club License Application (LCC-102) Livescan Fingerprint Background Request (LCC-105) - Instructions & Form. The Child Care Licensing Bureau is hosting eight Access Fairs this Spring. Step 2 Initial Information. Former names. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. (g) Child development. Forms State Applicant Fingerprint Electronic Processing Services (SAFE) Form Cynthia Lara, Director Child Care Licensing (803) 898-9024. Nestled in a quiet neighborhood of San Marcos is a California state licensed provider Lara Family Childcare run by Lara Trofimov. Enrollment Forms The first form parents should complete is an enrollment form, which can be attached to the childcare contract governing your daycare agreement. Ask for the Important Details. Licensed Child Care. State of Michigan - Department of Licensing and Regulatory Affairs - Child Care Licensing Instructions: Unless otherwise indicated, all requested information must be provided. An assistant caregiver may care for your child in my absence. Child Information Record BCAL-3731 Licensing Rules for Child Care Centers BCAL PUB 8 Health Appraisal [children] (MDHHS/BCAL-3305) - This form can only be downloaded and printed from our Web site or ordered from the Department of Health and Human Services, via fax at . Child Care Licensing Bureau. The required forms are part of rule and cannot be changed. Make the Form Easy to Register. The rule changes for Family and Group Child Care Homes took effect on December 13, 2019. Michigan Department of Licensing and Regulatory Affairs. Printable Child Care Forms - Attendance Records. Somewhere just inside the entryway is