The Child Care Licensing Division provides the following forms for use by:

  • Child care providers.
  • Child care centers.
  • Registered child-care homes.
  • Licensed child-care homes.
  • Child-placing agencies.
  • 24-hour care facilities.
  • Emergency shelters.
  • Foster homes.
  • Foster group homes.
  • Agency foster group homes.

You may use these forms to document information required by the minimum standards but using them is not required by Child Care Licensing.

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Number Form Name Description of Use for Providers
  Address Correction Form (PDF Document) Use this form to update, correct, or change contact information for Licensed Child Care Administrators and Licensed Child Placing Agency Administrators.
  Discipline and Guidance Policy (PDF Document) This form is a written discipline and guidance policy that complies with the requirements of Texas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance.
1001 FAST Pass for RCCL Foster Adoptive Applicants (PDF Document) This form must be completed for any Texas resident who requires a fingerprint background check and must be taken to the fingerprinting appointment.
1001a FAST Pass for RCCL Foster Adoptive Applicants - Non-Texas Residents (PDF Document) This form must be completed for any non-Texas resident fingerprint background check and must be taken to the fingerprinting appointment.
1100 Daily Building & Grounds Safety Checklist (PDF Document)  
2760
2760s
Controlling Person Form (PDF Document) | Spanish This form contains information required for Residential Operations to identify who is ultimately responsible for complying with standards and keeping children safe.
2784 General Residential Operation and Residential Treatment Center Documentation Required at Application (PDF Document) This form lists additional guidelines for materials required to accept an application.
2785 Child-Placing Agency Documentation Required at Application (PDF Document) This form lists additional guidelines for materials required to accept an application.
2786 Independent Foster Home Documentation Required at Application (PDF Document) This form lists additional guidelines for materials required to accept an application.
2820 Education Facility Request for Exemption(PDF Document) This form is used to determine whether an operation is exempt from DFPS regulation, based on criteria established in 40 Texas Administrative Code (TAC) §745.119 for an education facility.
2841 SEBCC Application Form (PDF Document) Use this form to submit an application to provide Small Employer Based Child Care.
2832 Request for Exemption - Single Skill Program Operating During the School Year(PDF Document)

Licensing uses this form to determine whether your program is exempt from DFPS regulation, based on the criteria established in 40 Texas Administrative Code (TAC) §745.129(2) for a single-skills program that operates  during the summer.

2833 Request for Exemption - Single Skill Program Operating During the Summer(PDF Document)

Licensing uses this form to determine whether your program is exempt from DFPS regulation, based on the criteria established in 40 Texas Administrative Code (TAC) §745.129(2) for a single-skills program that operates  during the summer.

2837 GOVERNMENTAL ENTITY – REQUEST FOR EXEMPTION FROM REGULATION UNDER 40 TAC §745.115 (PDF Document)  
2838 MISCELLANEOUS ENTITIES – REQUEST FOR EXEMPTION FROM REGULATION UNDER 40 TAC §745.129(PDF Document)  
2839 Program of Limited Duration Request for Exemption from Regulation Under 40 TAC §745.117(PDF Document)  
2846
2846s
Gang Free Zone Tip Sheet for Providers and Parents (PDF Document) | Spanish (PDF Document) House Bill 2086, which passed during the 81st Legislature, Regular Session and modified Chapter 42 of the Human Resource Code to include Section 42.064, became effective September 1, 2009. This form provides information about gang free zones that must be distributed to parents and guardians of children in care at licensed child-care centers in accordance with the new statute.
2869 Listed Family Home introduction letter (PDF Document)  
2873 Guidelines for listed family homes (PDF Document) This is an information sheet designed to help a Listed Family Home provider understand the laws and rules governing Listed Family Homes.
2885 Children's Products Certification (PDF Document) This form provides written certification that the provider has reviewed Consumer Product Safety Commission notifications and bulletins regarding unsafe children's products as required by minimum standard rules
2906 CPA Internal Investigation Report (PDF Document) Child Placing Agencies may voluntarily complete this form regarding internal investigations of an allegation or incident.
2911 Governing Body/Director Designation (PDF Document) This form must be completed when a director is named at an operation or to name a designee of a governing body.
2934 Medical History Report (PDF Document) New legislation requires parents who voluntarily relinquish parental rights of biological children or parents whose rights are terminated to complete this form describing theirs and their ancestors' medical histories.
2935 Admissions Information - Centers (PDF Document) / Spanish (PDF Document)

(includes Authorization for Emergency Medical Treatment)
Facilities must keep certain information for licensing regulations and the Child & Adult Care Food Program (CACFP). This form prevents duplication of effort by providers by keeping only one enrollment form for both programs. The CACFP program requires enrollment information to be updated annually.

By using this form, parents may give clear instructions for emergency medical treatment for their children.
2937 Child Care Waiver/Variance Request Form (PDF Document) Providers must use this form to request a waiver or variance.
2940 Child Care Administrative Review Request Form (PDF Document) Providers may use this form to request an administrative review.
2941 Child Care Operation Sign In-Out Log (PDF Document)  
2946 Local Law Enforcement Background Check Results for Prospective Foster Parents As part of the home study process, a child-placing agency must ask all prospective foster parents for information pertaining to any domestic violence calls made regarding their residence and any previous residences in the last 12 months. If the prospective foster parents disclose any such calls, the child-placing agency must request background information from the appropriate local law enforcement agency(ies) regarding the call(s). Results of the local law enforcement check must be reported to the agencys Licensing Representative. Use of this form is optional.
2947 Center Based Staff Information Record (PDF Document) This form simplifies maintenance of personnel records by centralizing information required by DFPS.
2948 Plan Of Operation For Licensed Child-Care Operations (PDF Document) This form describes how a day care operation plans to maintain compliance with the minimum standard rules and must be submitted with the application to operate a licensed child care center or licensed child care home.
2949 General Residential Operation Standards This form lists materials required and standards evaluated prior to issuance.
2950 Child-Placing Agency Standards This form lists materials required and standards evaluated prior to issuance.
2951 Independent Foster Home Rules: Evaluated Prior to Issuing an Initial License to a Non-Operating Home This form lists materials required and standards evaluated prior to issuance.
2954
2954s
Disclosure of Any Family Violence Calls to a Prospective Foster Home Applicants Place of Residence / Spanish (PDF Document) Prospective foster home applicants must disclose any incident(s) of law enforcement responding to a report of family violence at their residence in the 12 months preceding the application. This form must be completed and reviewed during the home study process for each prospective foster home.
2955
2955s
Licensing Fee Information (PDF Document) / Spanish (PDF Document) This form contains information for providers regarding the various fees and requirements of TDFPS.
2957 Parent Notification Poster for Center Based Care (PDF Document) This poster lists the information parents are entitled to view upon request and is required to be posted in a visible and publicly accessible place at the child-care center.
2957b Parent Notification Poster for Home Based Care (PDF Document) This poster lists the information parents are entitled to view upon request and must be posted in a visible and publicly accessible place at the child-care home.
2958 Keeping Children Safe Poster
English Color | English B&W
Spanish Color | Spanish B&W
This poster contains information about reporting suspected abuse/neglect, unsafe children's products, Sudden Infant Death Syndrome, Shaken Baby Syndrome, and protecting children from illness and disease.
2961 Request to Accept Children from Law Enforcement (PDF Document) This form must be submitted by a Child Placing Agency prior to accepting children from a Law Enforcement Officer.
2963 FAST Pass for GRO, CPA staff, or RCCL Foster Adoptive Household Members (PDF Document) This form must be completed for any Texas resident who requires a fingerprint background check and must be taken to the fingerprinting appointment.
2963a FAST Pass for GRO, CPA staff, or RCCL Foster Adoptive Household Members Applicants - Non-Texas Residents (PDF Document) This form must be completed for any non-Texas resident fingerprint background check and must be taken to the fingerprinting appointment.
2965 FAST Pass for Child Care Licensing (PDF Document) This form must be completed for any Texas resident who requires a fingerprint background check and must be taken to the fingerprinting appointment.
2965a FAST Pass for Child Care Licensing - Non-Texas Residents (PDF Document) This form must be completed for any non-Texas resident fingerprint background check and must be taken to the fingerprinting appointment.
2971
2971s
Request for Criminal History check/Central Registry Check (PDF Document) / Spanish (PDF Document) This information is required by DFPS and simplifies form completion for providers. Reduces errors in the information that must be presented to request these checks.
2974 Request for Risk Evaluation Based on Past Criminal History of Central Registry Findings This form is submitted to the Centralized Background Check Unit (CBCU) by an operation in order to request that the CBCU conduct a risk evaluation on a person based on his or her criminal and/or Central Registry history. Not all background check results are eligible for or require a risk evaluation. The CBCU will notify the operation if one is required.
2982 Personal History Statement (PDF Document) This form simplifies maintenance of records by centralizing information required by DFPS.
2985e
2985s
Affidavit for Applicants for Employment With a Licensed Operation or Registered Child-Care Home (PDF Document) / Spanish (PDF Document) This information is required by law and use of this form simplifies record keeping for providers.
2986 Listing request (PDF Document) Spanish (PDF Document) Use this form to submit a request to become a listed home.
2987 No Contact Letter to CPA (PDF Document) This letter is sent by Licensing when an attempt to reach a Child Placing Agency was made, but there was no contact.
2993 Administrative Penalty Fee form (PDF Document) This form must be attached to all payments submitted by any operation that has had administrative penalties imposed
2988a This form has been replaced by forms 3008, 3009, 3010, 3011, and 3012
3001 CPA Foster Parent Rights (PDF Document) Child Placing Agency staff and foster parents must sign this "Statement of Foster Parent and Child Placing Agency Rights and Responsibilities" at the time the home is verified.
3002 Independent Foster Home Rights (PDF Document) Child Care Licensing staff and foster parents must sign this "Statement of DFPS and Independent Foster Home Rights and Responsibilities" at the time the independent foster home receives an initial license.
3003 Foster Home Evaluation Checklist (PDF Document) This checklist is provided to specific foster homes for the purpose of complying with DFPS fire safety evaluation requirements.
3008 Listed Family Home Fee Schedule (PDF Document) This is the fee schedule form for a Listed Family Home
3009 Registered Child Care Fee Schedule(PDF Document) This is the fee schedule form for a Registered Child Care Home
3010 Licensed Child Care Fee Schedule (PDF Document) This is the fee schedule form for Licensed Child Care
3011 Residential Child Care Licensing Fee Schedule (PDF Document) This is the fee schedule form for 24-Hour residential child care
3012 Fee Schedule for Small Employer-Based Child Care Facilities and Temporary Shelter Child Care Facilities (PDF Document) This is the fee schedule form for Small Employer-Based Child Care and Temporary Child Care Facilities
7238 Authorization For Dispensing Medication (PDF Document) This information is required by DFPS and use of this form simplifies record keeping for providers.
7239 Incident/Illness Report (PDF Document) Providers may use this form to document details of any incident(s) that caused injury or placed a child or children at risk.
7240 Monthly Attendance Record (PDF Document) This information is required by DFPS and use of this form simplifies record keeping for providers.
7242 Registered Family Home Caregiver/Parent Agreement (PDF Document) This is an optional form that may be used by child-care home providers. This form does not take the place of written operational policies required by minimum standard rules.
7243 Emergency Telephone Numbers (PDF Document) This information is required by DFPS and enables providers to ensure the information is readily available.
7255E
7255s
Medication Authorization Form (PDF Document) / Spanish (PDF Document) This information is required by DFPS and use of this form simplifies record keeping for providers.
7258 Staff Training Record  
7261 Information on Reporting Child Abuse (PDF Document) This form provides an overview of abuse/neglect and instructions for reporting suspected abuse/neglect, and informs providers and parents of the law relating to abuse/neglect.
7263 Fire Safety Practices (PDF Document) Operations may use this form to document fire safety practices, such as fire and severe weather drills, and checks of the smoke alarms and fire extinguishers, as required by DFPS. Use of this form simplifies record keeping for providers.  
7293 Child Assessment Form (PDF Document) The questions on this form are designed to give providers the information needed to provide the most appropriate care for children. The information obtained on this form must remain confidential and cannot be shared without written permission from a parent/guardian.
7295 Information on Health Checks (PDF Document) This is an optional form designed to give child care operations that conduct health checks information on how to develop operational policies for health checks.