Child Care Licensing Forms

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.

• Child Care Center Application - Renewal
• Child Care Family and Group Home Application - Renewal

Child Care Center Checklists

• Child Care Center Compliance Record, Part 1. General Provisions
• Child Care Center Compliance Record, Part 2. Space and Equipment
• Child Care Center Compliance Record, Part 3. Staffing
• Child Care Center Compliance Record, Part 4. Health and Safety
• Child Care Center Compliance Record, Part 5. Program and Care
• Child Care Center Compliance Record, Part 6. Food Services and Nutrition
• Child Care Center Compliance Record, Part 7. Specific Provisions and Exemptions
• Child Care Center Compliance Record, Part 8. Fire Safety
• Child Care Center Compliance Record, Part 9. Transportation
• Child Care Center Compliance Record, Part 10. Swimming
• Child Care Center Record Requirements - CCL-5041

Child Care Family and Group Home Checklists

• Child Care Family and Group Home Compliance Record, Part 1. General Provisions
• Child Care Family and Group Home Compliance Record, Part 2. Space and Equipment
• Child Care Family and Group Home Compliance Record, Part 3. Staffing
• Child Care Family and Group Home Compliance Record, Part 4. Health and Safety
• Child Care Family and Group Home Compliance Record, Part 5. Program and Care
• Child Care Family and Group Home Compliance Record, Part 6. Fire Safety
• Child Care Family and Group Home Compliance Record, Part 7. Transportation
• Child Care Family and Group Home Record Requirements - CCL-5040

Background Check and Fingerprinting Information

Center Fire and Tornado Drill Record - CCL-4593

Certification of School Building Fire Safety Provisions CCL-5043

Change of Use Space Request for School-Age Programs Located in Schools CCL-4342

Child Care Center Notice of Arraignment or Conviction CCL-1486

Child Care License Designee CCL-5003

Child Care Licensing Information Request - BCHS-CCL 001

Child Information Record - CCL-3731

Child Information Record - BCAL 3731- Arabic

Documento de Información del Niño Estado de Michigan - BCAL-3731-Spanish

Corrective Action Plan - CCL-1894

Health Appraisal - MDHHS-3305

Incident Report CCL-4605

Infant/Toddler Primary Caregiver Documentation CCL-4557

Lead Inspection Risk Assessment Summary CCL-4344

Lead Inspection Risk Assessment Waiver

Licensing Notebook Summary Sheet - CCL-5052

Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243

Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243-SP

Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591

Multiple Occupancy Documentation for Child Care Centers – CCL- 2118

No Change in Building Construction Declaration CCL-2129

Ownership Interest Disclosure – CCL-2119

Parent Notification of the Licensing Notebook CCL-5053

Playground Inspection Certification Summary CCL-5047

Provisional Waiver - CCL-1004

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

Request of Child Care Forms – CCL-2021

Self-Certification of Transportation Provisions for Centers CCL-5044

Staffing Plan: Child Care Center CCL-5001 - Excel

Staffing Plan: Child Care Center CCL-5001

Volunteer Certification for Field Trip Transportation CCL-5046

Written Information Packet Documentation CCL-4340

Module 3, Staffing:

• 3.4 Child Care Center Information and Policy Acknowledgement Form - Word
• 3.5 Center Training (R 400.8216 and R 400.8216a) Checklist - PDF

Module 4, Communication and Notifications:

• 4.1 Sample Written Information Packet - Word

Module 6, General Health and Safety:

• 6.2 Safe and Healthy Diaper Changing - PDF
• 6.6 Fire Emergency Plan - PDF
• 6.6 Accident Injury Plan - PDF
• 6.6 Accident Injury Plan - Word
• 6.6 Tornado Emergency Plan - PDF
• 6.6 Tornado Emergency Plan - Word
• 6.6 Be Prepared for a Winter Storm - PDF
• 6.6 Be Prepared for a Power Outage - PDF
• 6.6 Gas Leak, Water Main Break, Winter Storm Emergency Plans - PDF
• 6.6 Gas Leak, Water Main Break, Winter Storm Emergency Plans - Word
• 6.6 Bomb Threat, Power Outage, or Suspicious Packages Emergency Plans - PDF
• 6.6 Bomb Threat, Power Outage, or Suspicious Packages Emergency Plans - Word
• 6.6 Sample Missing Child Emergency Protocol - PDF
• 6.6 Sample Missing Child Emergency Protocol - Word
• 6.6 Continuing Operations During and After a Disaster Sample Plan - Word

Module 7, Program and Care:

• 7.4 Center Discipline Policy Example Template - PDF

Module 9, Food Safety and Nutrition:

• 9.5 Editable Menu

Module 10, Transportation Permission Form:

• 10.5 Sample Transportation Permission Form - Word

Background Check and Fingerprinting Information

Child Care Licensing Information Request - CCL 001

Child in Care Statement/Receipt - CCL-3900
Declaración/Recibo de Niños en Cuidado - CCL-3900 - Spanish

Child Information Record - CCL-3731
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

Corrective Action Plan - CCL-1894

Driver Verification - CCL-5039

Family and Group Home Increased Capacity and Ratio Request

Home Fire and Tornado Drill Record - CCL-4593

Incident Report - CCL-4605

Licensing Notebook Summary Sheet - CCL-5052

Medical Clearance Request - CCL-3704

Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243
Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - CCL-1243 - Spanish

Notification of Changes in Status-Family and Group Child Care Home - CCL-1485

Provisional Waiver - CCL-1004

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

Request of Child Care Forms – CCL-2021

Sample Attendance Record

Training Record Family/Group Child Care Homes - CCL-4590

Waiver for Decreasing Capacity

Zoning Approval for Group Child Care Homes - CCL-3748