Instructions For Licensed Child Care Provider Agreement printable pdf download

Instructions For Licensed Child Care Provider Agreement

STATE OF NEW HAMPSHIRE

Form 2631(i)

Department of Health and Human Services

May 2005

Division for Children, Youth and Families

Instructions for License-Exempt Child Care Provider Agreement

PURPOSE:

All license-exempt child care providers enrolled through the Department of Health and Human

Services to receive payments for providing child care through Child Care and Development Fund

Scholarships must date and sign the agreement upon enrollment.

INSTRUCTIONS:

Form 2631 is a two page form completed by the child care provider. The completed form is forwarded

to the Child Development Bureau, DCYF.

The Child Development Bureau will return forms that have missing or incomplete information.

The Child Development Bureau will retain a copy of the completed form in the providers file.

FORM COMPLETION:

Enter the full legal name and address of the child care provider on page 1.

Read the entire document and if you have any questions contact the Bureau of Child Development.

Sign and date the form.

Photocopy and keep a copy for your records.

RETENTION:

Form 2631 is retained permanently in the providers file.

PD 05-04

Instructions For Licensed Child Care Provider Agreement