Child Care Provider Forms

Provider Paperwork

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Provider Paperwork

Child care providers are required to submit specific paperwork as part of the application and renewal process. All required provider paperwork must be submitted to your Licensing Specialist via the online Child Care Licensing system.

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  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Daily Program Schedule
  • Fire Inspection
  • Growing Futures Training Record
  • Indoor Square Footage Map
  • Local or Regional Requirements, if applicable
  • Outdoor Square Footage Map
  • Pediatric CPR/AED & Pediatric First Aid Certification
  • Pet Vaccination Records, if applicable
  • Policies & Contracts
  • SFN 433 Child Abuse and Neglect Background Inquiry for household members aged 12-17
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Daily Program Schedule
  • Director/Supervisor Qualifications
  • Fire Inspection
  • Growing Futures Training Records
  • Health/Sanitation Inspection for non-residential facilities if meals are prepared
  • Indoor Square Footage Map
  • Local or Regional Requirements, if applicable
  • Outdoor Square Footage Map
  • Pediatric CPR/AED & Pediatric First Aid Certifications
  • Pet Vaccination Records, if applicable
  • Policies & Contracts
  • SFN 433 Child Abuse and Neglect Background Inquiry for household members aged 12-17 if care is provided in a residence
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Daily Program Schedule
  • Director/Supervisor Qualifications
  • Fire Inspection
  • Growing Futures Training Records
  • Health/Sanitation Inspection if meals are prepared
  • Indoor Square Footage Map
  • Liability Insurance
  • Local or Regional Requirements, if applicable
  • Outdoor Square Footage Map
  • Pediatric CPR/AED & Pediatric First Aid Certifications
  • Pet Vaccination Records, if applicable
  • Policies & Contracts
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Daily Program Schedule
  • Director/Supervisor Qualifications
  • Fire Inspection
  • Growing Futures Training Records
  • Health/Sanitation Inspection for non-residential facilities if meals are prepared
  • Indoor Square Footage Map
  • Liability Insurance
  • Local or Regional Requirements, if applicable
  • Outdoor Square Footage Map
  • Pediatric CPR/AED & Pediatric First Aid Certifications
  • Pet Vaccination Records, if applicable
  • Policies & Contracts
  • Preschool Teacher Qualifications
  • SFN 433 Child Abuse and Neglect Background Inquiry for household members aged 12-17 if care is provided in a private residence
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Daily Program Schedule
  • Director/Supervisor Qualifications
  • Fire Inspection
  • Growing Futures Training Records
  • Health/Sanitation Inspection for non-residential facilities if meals are prepared
  • Indoor Square Footage Map
  • Liability Insurance
  • Local or Regional Requirements, if applicable
  • Outdoor Square Footage Map
  • Pediatric CPR/AED & Pediatric First Aid Certifications
  • Pet Vaccination Records, if applicable
  • Policies & Contracts
  • SFN 433 Child Abuse and Neglect Background Inquiry for household members aged 12-17 if care is provided in a private residence
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

  • Application for licensure/self-declaration, completed online via the Child Care Licensing system
  • Aquatic Policy
  • Auto Liability Insurance, if transportation is provided
  • Criminal Background Check Memorandums
  • Growing Futures Training Records
  • Local or Regional Requirements, if applicable
  • Pediatric CPR/AED & Pediatric First Aid Certifications
  • Pet Vaccination Records, if applicable
  • SFN 433 Child Abuse and Neglect Background Inquiry for household members aged 12-17 if care is provided in a private residence
  • SFN 517 Child Care Evacuation Disaster Plan, completed online via the Child Care Licensing system

Forms for Families

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Forms for Families

Child care providers must maintain the following records for each enrolled child.  Child records must be made available to the Licensing Specialist during monitoring visits.

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Child Information Sheet SFN 845

  • Completed by the parent or legal guardian at the time of initial enrollment and updated as needed
  • It is a good practice to have families review the information annually to ensure information is up to date

Parent’s Statement on Health of Child SFN 847

  • Completed by the parent or legal guardian at the time of initial enrollment
  • A new form must be completed annually

  • Parents or legal guardians may submit a record from their medical provider or have a medical professional complete and sign the Certificate of Immunization SFN 16038
  • If claiming an immunization exemption, families should complete the Statement of Exemption to Immunization Law section of Certificate of Immunization SFN 16038
    • Children may be exempt from immunization requirements for the following reasons:
      • Medical Exemption: Requires a certificate signed by a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child
      • History of Disease: Requires a certificate signed by a physician stating that the child has a history of disease. History of disease exemptions may be claimed for measles, mumps, rubella, chickenpox, hepatitis A, or hepatitis B
      • Personal Belief or Religious Belief Exemption: Requires a certificate signed by the parent or guardian whose sincerely held philosophical, moral or religious belief is opposed to such immunization
  • All children need to be up-to-date according to the child care immunization requirements or have claimed an exemption within 30 days of enrollment or be excluded from child care
  • Additional Child Care Immunization and Infectious Disease Resources

  • A written health care plan is required by licensing for children with a diagnosed special need. The plans give child care providers the vital information they need to manage the child’s condition on a daily basis, what to do in an emergency, and how to help the child participate as fully as possible in the child care program.

Need Sample Forms?

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Need Sample Forms?

Child Care Aware® of North Dakota serves as a resource hub for child care professionals, offering a large variety of sample forms including safe sleep, health care plans, medication administration, and permission forms.

Find Sample Forms Now

Questions? Contact Us

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Questions? Contact Us

Early Childhood
600 E. Boulevard Avenue, Dept. 325
Bismarck, ND 58505-0250

Phone: (701) 328-2115
Toll-Free: (800) 997-8516
Relay ND TTY: 711
Email: dhsec@nd.gov