Child Care Licensing Forms

Child Care Center Checklists

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

Child Care Family and Group Home Checklists

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

• Background Check and Fingerprinting Information
• Center Fire and Tornado Drill Record - CCL-4593 (PDF)
• Certification of School Building Fire Safety Provisions CCL-5043 (PDF)
• Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 (PDF)
• Child Care Center Notice of Arraignment or Conviction CCL-1486 (PDF)
• Child Care License Designee CCL-5003 (PDF)
• Child Care Licensing Information Request - BCHS-CCL 001 (PDF)
• Child Information Record - CCL-3731 (PDF)
• Child Information Record - BCAL 3731- Arabic (PDF)
• Documento de Información del Niño Estado de Michigan - BCAL-3731-Spanish (PDF)
• Corrective Action Plan - CCL-1894 (PDF)
• Health Appraisal - MDHHS-3305 (PDF)
• Incident Report CCL-4605 (PDF)
• Infant/Toddler Primary Caregiver Documentation CCL-4557 (PDF)
• Lead Inspection Risk Assessment Summary CCL-4344 (PDF)
• Lead Inspection Risk Assessment Waiver (PDF)
• Licensing Notebook Summary Sheet - CCL-5052 (PDF)
• Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 (PDF)
• Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderías - CCL-1243-SP (PDF)
• Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 (PDF)
• Multiple Occupancy Documentation for Child Care Centers – CCL-2118 (PDF)
• No Change in Building Construction Declaration CCL-2129 (PDF)
• Ownership Interest Disclosure – CCL-2119 (PDF)
• Parent Notification of the Licensing Notebook CCL-5053 (PDF)
• Playground Inspection Certification Summary CCL-5047 (PDF)
• Provisional Waiver - CCL-1004 (PDF)
• Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 (PDF)
      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 of Child Care Forms – CCL-2021 (PDF)
• Self-Certification of Transportation Provisions for Centers CCL-5044 (PDF)
• Staffing Plan: Child Care Center CCL-5001 (Excel)
• Staffing Plan: Child Care Center CCL-5001 (PDF)
• Volunteer Certification for Field Trip Transportation CCL-5046 (PDF)
• Written Information Packet Documentation CCL-4340 (PDF)

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 (Word)

Module 9, Food Safety and Nutrition:

• 9.5 Editable Menu (PPT)

Module 10, Transportation Permission Form:

• 10.5 Sample Transportation Permission Form (Word)

• Background Check and Fingerprinting Information
• Child Care Licensing Information Request - CCL 001 (PDF)
• Child in Care Statement/Receipt - CCL-3900 (PDF)
  Declaración/Recibo de Niños en Cuidado - CCL-3900 - Spanish (PDF)
• Child Information Record - CCL-3731 (Word)
  Child Information Record - CCL 3731 - Arabic (PDF)
  Documento de Información del Niño Estado de Michigan - CCL-3731 - Spanish (PDF)
• Child Care Staff Member Certifications and Child Care Assistant Certifications - CCL-4595 (PDF)
• Corrective Action Plan - CCL-1894 (PDF)
• Driver Verification - CCL-5039 (PDF)
• Family and Group Home Increased Capacity and Ratio Request (PDF)
• Home Fire and Tornado Drill Record - CCL-4593 (PDF)
• Incident Report - CCL-4605 (PDF)
• Licensing Notebook Summary Sheet - CCL-5052 (PDF)
• Medical Clearance Request - CCL-3704 (PDF)
• Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 (PDF)
  Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderías - CCL-1243 - Spanish (PDF)
• Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 (PDF)
• Provisional Waiver - CCL-1004 (PDF)
• Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 (PDF)
      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 of Child Care Forms – CCL-2021 (PDF)
• Sample Attendance Record (Excel)
• Training Record Family/Group Child Care Homes - CCL-4590 (PDF)
• Waiver for Decreasing Capacity (PDF)
• Zoning Approval for Group Child Care Homes - CCL-3748 (PDF)

Module 5, Sample Emergency Plans and Procedures:

5.6 Sample Emergency Plans and Procedures

Module 6, Sample Home Discipline Policy:

6.3 Sample Home Discipline Policy 

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 (PDF)
• Child Care Family and Group Home Application - Renewal (PDF)