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.
If you do not have a credit card or a debit card to pay the fee online, please submit a paper renewal application with a check or money order payable to the State of Michigan. The renewal fee is $25 for family homes, $50 for group homes, and based on capacity for centers.
Background Check and Fingerprinting Information
Center Fire and Tornado Drill Record - CCL-4593 - PDF
Center Fire and Tornado Drill Record - CCL-4593 - Word
Certification of School Building Fire Safety Provisions CCL-5043 - PDF
Certification of School Building Fire Safety Provisions CCL-5043 - 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
Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF
Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word
Child Care License Designee CCL-5003 - PDF
Child Care License Designee CCL-5003 - Word
Child Care Licensing Information Request - BCHS-CCL 001 - PDF
Child Care Licensing Information Request - BCHS-CCL 001 - Word
Child Information Record - CCL-3731 - Word
Child Information Record - BCAL 3731- Arabic
Documento de Información del Niño Estado de Michigan - BCAL-3731-Spanish
Corrective Action Plan - CCL-1894 - PDF
Corrective Action Plan - CCL-1894 - Word
Incident Report CCL-4605 - PDF
Incident Report CCL-4605 - Word
Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF
Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word
Lead Inspection Risk Assessment Summary CCL-4344 - PDF
Lead Inspection Risk Assessment Summary CCL-4344 - Word
Lead Inspection Risk Assessment Waiver - PDF
Lead Inspection Risk Assessment Waiver - Word
Licensing Notebook Summary Sheet - CCL-5052 - PDF
Licensing Notebook Summary Sheet - CCL-5052 - 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
Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - PDF
Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - Word
Multiple Occupancy Documentation for Child Care Centers – CCL- 2118 – PDF
Multiple Occupancy Documentation for Child Care Centers – CCL- 2118 – Word
No Change in Building Construction Declaration CCL-2129 - PDF
No Change in Building Construction Declaration CCL-2129 - Word
Ownership Interest Disclosure – CCL-2119 – PDF
Ownership Interest Disclosure – CCL-2119 – Word
Parent Notification of the Licensing Notebook CCL-5053 PDF
Parent Notification of the Licensing Notebook CCL-5053 - Word
Playground Inspection Certification Summary CCL-5047 - PDF
Playground Inspection Certification Summary CCL-5047 Word
Provisional Waiver - CCL-1004 - PDF
Provisional Waiver - CCL-1004 - Word
Report of Actual or Suspected Child Abuse or Neglect - DHS-3200
Request for Modification of the Terms of the License - CCL-5054 - PDF
Request for Modification of the Terms of the License - CCL-5054 - Word
Request of Child Care Forms – CCL-2021 – PDF
Request of Child Care Forms – CCL-2021 – Word
Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF
Self-Certification of Transportation Provisions for Centers CCL-5044 - Word
Staffing Plan: Child Care Center CCL-5001 - Excel
Staffing Plan: Child Care Center CCL-5001 - PDF
Staffing Plan: Child Care Center CCL-5001 – Word
Volunteer Certification for Field Trip Transportation CCL-5046 - PDF
Volunteer Certification for Field Trip Transportation CCL-5046 - Word
Written Information Packet Documentation CCL-4340 - PDF
Background Check and Fingerprinting Information
Child Care Licensing Information Request - CCL 001 - PDF
Child Care Licensing Information Request - CCL 001 - Word
Child in Care Statement/Receipt - CCL-3900 - PDF
Child in Care Statement/Receipt - CCL-3900 - Word
Declaración/Recibo de Niños en Cuidado - CCL-3900-Spanish
Child Information Record - CCL-3731 - PDF
Child Information Record - CCL-3731 - Word
Child Information Record - CCL 3731 - Arabic
Documento de Información del Niño Estado de Michigan - CCL-3731 - Spanish
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
Corrective Action Plan - CCL-1894 - PDF
Corrective Action Plan - CCL-1894 - Word
Driver Verification - CCL-5039 - PDF
Driver Verification - CCL-5039 - Word
Family and Group Home Increased Capacity and Ratio Request - PDF
Family and Group Home Increased Capacity and Ratio Request – Word
Home Fire and Tornado Drill Record - CCL-4593 - PDF
Home Fire and Tornado Drill Record - CCL - 4593 - 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
Medical Clearance Request - CCL-3704 - PDF
Medical Clearance Request - CCL-3704 - 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
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
Provisional Waiver - CCL-1004 - PDF
Provisional Waiver - CCL-1004 - Word
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.
Request for Modification of the Terms of the License - CCL-5054 - PDF
Request for Modification of the Terms of the License - CCL-5054 - Word
Request of Child Care Forms – CCL-2021 – PDF
Request of Child Care Forms – CCL-2021 – Word
Sample Attendance Record
Training Record Family/Group Child Care Homes - CCL-4590 PDF
Training Record Family/Group Child Care Homes - CCL-4590 - Word
Waiver for Decreasing Capacity – PDF
Waiver for Decreasing Capacity – Word
Zoning Approval for Group Child Care Homes - CCL-3748 - PDF
Zoning Approval for Group Child Care Homes - CCL-3748 - Word
