• Family Day Care

• Group Day Care Home/ Child Day Care Center

Family Day Care Licensure Applications   

• Application - Initial (pdf)

  • Application Checklist (pdf)

  • Initial Application Fee Invoice Form (pdf)

  • Worker's Compensation Insurance Form (pdf)

• Application - Renewal

  • Renewal Cover Letter (pdf)

  • Renewal Fee Invoice Form (pdf)

• Change of Address Application (pdf)

• Application and Renewal Application - Family Day Care Home Staff (pdf)

Related Forms  

• Adult Medical Statement for Child Day Care (pdf)

• Authorization for the Administration of Medication by Child Day Care Personnel (pdf)

• Parent/Guardian Authorization for the Administration of Non-Prescription Topical Medication (pdf)

• Child Day Care Incident Log (pdf)

• Child Enrollment (pdf)

• DCF Authorization for Release of Information (pdf)

• Early Childhood Health Assessment Record (pdf)

• Emergency Medical Care (pdf)

• Emergency Telephone Numbers (pdf)

• General Report of Change (pdf)

• Family Day Care Inspection Form (Sample) (pdf)

• Initial Application Cover Letter (pdf)

• Application Checklist (pdf)

• Initial Application Fee Invoice Form (pdf)

• Affidavit (pdf)

• Application for Initial License (pdf)

• Supplementary Information for Infant/Toddler Care (pdf)

• "Sample" Policies, Plans & Procedures (pdf)

• Renewal Cover Letter (pdf)

• Renewal Fee Invoice Form (pdf)

• Early Childhood Education Consultant (pdf)

• Head Teacher - Group (pdf)

• Head Teacher - Center (pdf)

• Head Teacher -  School Age (pdf)

• Approval for Child Day Care (pdf)

• Authorization for the Administration of Medication by Child Day Care Personnel (pdf)

• Parent/Guardian Authorization for the Administration of Non-Prescription Topical Medication (pdf)

• Child Day Care/Group Day Care Home Inspection Form (Sample) (pdf)

• Consultant/Head Teacher Data Sheet (pdf)

• DCF Authorization for the Release of Information (pdf)

• Early Childhood Health Assessment Record (pdf)

• Fire Marshall Inspection Certificate (pdf)

• Individual Staff Professional Development (pdf)

• Notification of Proposed Changes (pdf)

• Staff Health Record Result of Tuberculin Test and Statement of Health Status (pdf)

• Staff Work Schedule (pdf)

• Water Supply (pdf)

• Worker's Compensation Insurance Form (pdf)

Legal Office CT Department of Public Health

410 Capitol Avenue MS #12 LEG

P.O. Box 340308

Hartford, CT 06134-0308

Telephone #:  860-509-7600