Family Child Care Sample Forms Packet
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12THE COMMONWEALTH OF MASSACHUSETTS
Department of Early Education and Care
FAMILY CHILD CARE SAMPLE FORMS PACKET
Dear Family Child Care Provider,
Providing high quality child care is a rewarding, professional experience, where you have the ability to
make a lasting positive impact on the lives of children. In order to aid you in your work, the
Department of Early Education and Care (EEC) is pleased to provide you with the following packet of
sample forms and documents. EEC designed these forms to guide you with examples of the
information that you need to document according to EEC licensing standards. These documents are
a crucial part of the quality child care experience. You may make copies of these forms or create your
own based upon the information they contain. Please pay close attention to the information requested
and be sure it is all included if you decide to create your own forms. The forms contained in this
packet are:
•
Annual Update Form: Once a child has been in care for a year, you must have the parent review
and update any information and written permission forms in their child’s file. Use this form to
ensure all information has been updated.
•
Changes in Household Composition: If there are any changes in your household during the 3
year licensing period (i.e. new baby, adopted child, foster children, any person 15 or older that will
be present for more than 30 days) you must submit the required information to the Department.
•
Evacuation/Smoke Detector Log: You must conduct evacuation drills at least once per month
from each approved floor level. This sample form also contains a Smoke Detector Log to
document your monthly test of your smoke detectors. These logs will be checked by a licensor on
routine visits.
•
Indirect Supervision Form: Use this form to obtain written parental permission for children
seven years of age or older to use approved space without direct supervision and leave the child
care premises without direct supervision.
•
Outdoor Play with Periodic Supervision: This form can only be used with children 5 years of
age or older if the outdoor play space is enclosed by a fence at least 4 feet high and it is located
on the child care premises of a single family or first floor residence.
•
Parental Permission for Medication and Record of Medication Administration: Use this form
to get written permission for any prescription or non-prescription medication the parent/guardian
may ask you to administer. Use the log to document what you have given.
•
Record of Observations: Use this form to document any serious or unusual marks, bruises,
injuries or repetitive occurrences such as a severe diaper rash that are observed on the child
upon arrival at the child care home or throughout the day.
•
Special Excursion (Field Trip): Use this form for any trip that is not listed on the "General
Permission" form in the family child care enrollment packet.
•
Permission for Use of On-Site Swimming Pool: Use this form to obtain written parental
permission for children to use an on-site Swimming Pool. Please remember that children must be
directly supervised at all times during activities involving water.
•
Family Child Care Incident Report: Use this form to document any minor or serious incidents
that occur in your program. Any serious incident must be immediately reported to EEC and this
form mailed within 48 hours. Minor incident should be documented for your records.
Page 1 of 12
FCCSampleFormPacket20100203
ADVERTISEMENT
0 votes
Related Articles
Related forms
On Call Agreement Child Care Centers And Large Family Child Care Homes Form - Maryland State Department Of Education
Legal
Form 150-101-170 - Schedule Wfc-n/p - Oregon Working Family Child Care Credit For Part-year Residents And Nonresidents - 2014
Financial
Form 150-101-170 - Schedule Wfc-n/p - Oregon Working Family Child Care Credit For Form 40n And Form 40p Filers - 2009
Legal
Related Categories
Parent category: Legal