Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. The PDF versions are not fillable and are intended for printing. The Word documents are fillable and are intended for electronic completion.
Family and Group Home Increased Capacity and Ratio Request - Word Version
Family and Group Home Increased Capacity and Ratio Request – PDF Version
Waiver for Decreasing Capacity – Fillable Word Version
Waiver for Decreasing Capacity – PDF Version
Request of Child Care Forms – CCL-2021 – PDF
Request of Child Care Forms – CCL-2021 – Word
Child Care Licensing Information Request - CCL 001 -PDF
Child Care Licensing Information Request - CCL 001 - Word
Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 PDF
Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 Word
Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF
Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word
Background Check and Fingerprinting Information
Report of Actual or Suspected Child Abuse or Neglect - DHS-3200
Complete this form within 72 hours of calling in a suspicion of abuse or neglect.
Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - PDF
Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - Word
Medical Clearance Request - CCL-3704 - PDF
Medical Clearance Request - CCL-3704 - Word
Child Information Record - CCL-3731 - PDF
Child Information Record - CCL-3731 - Word
Child Information Record - CCL 3731-AR (Arabic)
Documento de Información del Niño Estado de Michigan - CCL-3731-SP
Zoning Approval for Group Child Care Homes - CCL-3748 - PDF
Zoning Approval for Group Child Care Homes - CCL-3748 - Word
Declaración/Recibo de Niños en Cuidado - CCL-3900-SP
Child in Care Statement/Receipt - CCL-3900 - PDF
Child in Care Statement/Receipt - CCL-3900 - Word
Corrective Action Plan - CCL-1894 - PDF
Corrective Action Plan - CCL-1894 - Word
Training Record Family/Group Child Care Homes - CCL-4590 PDF
Training Record Family/Group Child Care Homes - CCL-4590 - Word
Child Care Staff Member Certifications and Child Care Assistant Certifications - CCL-4595 - PDF
Child Care Staff Member Certifications and Child Care Assistant Certifications - CCL-4595 - Word
Driver Verification - CCL-5039 - PDF
Driver Verification - CCL-5039 - Word
Home Fire and Tornado Drill Record - CCL-4593 - PDF
Home Fire and Tornado Drill Record - CCL - 4593 - Word
Licensing Notebook Summary Sheet - CCL-5052 - PDF
Licensing Notebook Summary Sheet - CCL-5052 - Word
Request for Modification of the Terms of the License - CCL-5054 - PDF
Request for Modification of the Terms of the License - CCL-5054 - Word
Provisional Waiver - CCL-1004 - PDF
Provisional Waiver - CCL-1004 - Word
Variance Request Early Childhood Program Director – Fillable Word Version
Variance Request Early Childhood Program Director – PDF Version
Variance Request School-Age Program Director – Fillable Word Version
Variance Request School-Age Program Director – PDF Version
Variance Request Lead Caregiver – Fillable Word Version
Variance Request Lead Caregiver – PDF Version
Request of Child Care Forms – CCL-2021 – PDF
Request of Child Care Forms – CCL-2021 – Word
Child Care Licensing Information Request - BCHS-CCL 001 - PDF
Child Care Licensing Information Request - BCHS-CCL 001 - Word
Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - PDF
Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - Word
Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF
Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word
Background Check and Fingerprinting Information
Report of Actual or Suspected Child Abuse or Neglect - DHS-3200
Complete this form within 72 hours of calling in a suspicion of abuse or neglect.
Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF
Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word
Child Information Record - CCL-3731 - PDF
Child Information Record - CCL-3731 Web Proected
Child Information Record - BCAL 3731-AR (Arabic)
Documento de Información del Niño Estado de Michigan - BCAL-3731-SP
Written Information Packet Documentation CCL-4340 - PDF
Written Information Packet Documentation CCL-4340 - Word
Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - PDF
Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - Word
Lead Hazard Risk Assessment Summary CCL-4344 - PDF
Lead Hazard Risk Assessment Summary CCL-4344 - Word
Corrective Action Plan - CCL-1894 - PDF
Corrective Action Plan - CCL-1894 - Word
No Change in Building Construction Declaration CCL-2129 - PDF
No Change in Building Construction Declaration CCL-2129 - Word
Health Appraisal - MDHHS/BCAL-3305
Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF
Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word
Center Fire and Tornado Drill Record - CCL-4593 - PDF
Center Fire and Tornado Drill Record - CCL-4593 - Word
Staffing Plan: Child Care Center CCL-5001 - PDF
Staffing Plan: Child Care Center CCL-5001 - Word
Staffing Plan: Child Care Center CCL-5001 – Excel
Child Care License Designee CCL-5003 - PDF
Child Care License Designee CCL-5003 - Word
Certification of School Building Fire Safety Provisions CCL-5043 - PDF
Certification of School Building Fire Safety Provisions CCL-5043 - Word
Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF
Self-Certification of Transportation Provisions for Centers CCL-5044 - Word
Volunteer Certification for Field Trip Transportation CCL-5046 - PDF
Volunteer Certification for Field Trip Transportation CCL-5046 - Word
Playground Inspection Certification Summary CCL-5047 - PDF
Playground Inspection Certification Summary CCL-5047 Word
Incident Report CCL-4605 - PDF
Incident Report CCL-4605 - Word
Licensing Notebook Summary Sheet - CCL-5052 - PDF
Licensing Notebook Summary Sheet - CCL-5052 - Word
Parent Notification of the Licensing Notebook CCL-5053 PDF
Parent Notification of the Licensing Notebook CCL-5053 - Word
Request for Modification of the Terms of the License - CCL-5054 - PDF
Request for Modification of the Terms of the License - CCL-5054 - Word
Provisional Waiver - CCL-1004 - PDF
Provisional Waiver - CCL-1004 - Word
Multiple Occupancy Documentation for Child Care Centers – CCL- 2118 – PDF
Multiple Occupancy Documentation for Child Care Centers – CCL- 2118 – Word
