Child Care Licensing (CCL) provides these forms and documents for both day care and residential (24-hour) child care providers, including foster homes, child-placing agencies, and emergency shelters.

Note: If you already know which form or document you need, you can use 'CTRL + F' to find specific form numbers and titles. Not all forms are required. Before you fill out any forms, please start by contacting your local child care licensing office.

DFPS Privacy and Security Policy / DFPS Política de Confidencialidad

General Information

Forms

Number Title Purpose
None Discipline and Guidance Policy Day care providers must have staff, parents, and household members read and sign a copy of this form to demonstrate compliance with regulations.
Keep a copy of the signed form in each child’s record.
1100 Daily Building & Grounds Safety Checklist / PDF Document Providers may use this form or create their own for the required daily grounds & building safety check.
2550 Operational Policy on Infant Safe Sleep - J-800-2550  
2710 Infant Sleep Exception - Health-Care Professional - J-800-2710 When a health-care professional determines that it is medically necessary for an infant to sleep in an alternative position (other than sleeping on the infant's back), sleep in a restrictive device (such as a bouncer seat or swing), or needs to be swaddled to sleep, use this form to ensure that a licensed child-care center, licensed child-care home, or registered child-care home that cares for the infant meets the minimum standards required by Texas Human Resources Code §42.042(e)(8).
2885 Children's Products Certification / PDF Document Providers complete this form to certify that they have reviewed Consumer Product Safety Commission notifications and bulletins regarding unsafe children's products as required by minimum standards rules.
2935 Admissions Information - Centers / PDF Document
Spanish
/ PDF Document

(includes Authorization for Emergency Medical Treatment)
Day care providers have the parent or guardian complete this form and keep it on file at the child-care facility.
This form prevents duplication of effort by keeping only one enrollment form for both the Child & Adult Care Food Program (CACFP) and licensing. The CACFP program requires enrollment information to be updated annually.
2937 Child Care Waiver/Variance Request Form / PDF Document / Instructions Providers without an online account complete this form to request a waiver or variance from a minimum standard.
2940 Child Care Administrative Review Request Form / PDF Document
Spanish
Providers complete this form to request an administrative review of a licensing decision or action.
2941 Child Care Operation Sign In-Out Log / PDF Document Providers have the parent or guardian sign this form each time a child is dropped off or picked up. Providers must keep this information for at least the previous 3 months. Providers may use their own form.
2962 Verification of Insurance Licensed operations may use this form or their own to document liability insurance or an acceptable reason as to why the operation does not have to be insured.
7239 Incident/Illness Report / PDF Document
Spanish
Providers may use this form to document any incident that caused injury or placed a child at risk. Providers may also use their own form.
7240 Monthly Attendance Record / PDF Document All day care providers must maintain required attendance logs. This form should be kept on file at the facility for three months. Providers may also use their own form.
7242 Registered Family Home Caregiver/Parent Agreement / PDF Document Registered family home providers may use this optional form to document an agreement for child care with the parent. This form does not take the place of written operational policies required by minimum standards rules.
7263 Emergency Practices All providers must use this form to document required fire safety practices. Providers may also use their own form.
7293 Child Assessment Form / PDF Document Day care providers may have parents complete this form at enrollment about each child’s individual needs.

Documents

Number Title Purpose
2873
2873s
Guidelines for listed family homes
Spanish
This document assists a Listed Family Home in understanding the laws and rules governing Listed Family Homes. Informational only.
7295 Information on Health Checks / PDF Document All day care providers may consult this document on how to develop policies for health checks.
Informational only.

Application Information

Forms

Number Title Purpose
2841 Small Employer-Based Child Care or Temporary Shelter Child Care Facility Application Submit this application to provide Small Employer-Based Child Care.
2948 Plan Of Operation For Licensed Child-Care Operations Submit this form with the application to become a licensed child-care center or licensed child-care home.
2949 General Residential Operation Standards Do not complete this form; it is informational only. Licensing staff complete this form to evaluate whether standards are met before issuing a license.
2950 Child Placing Agency Standards Do not complete this form; it is informational only. Licensing staff complete this form to evaluate whether standards are met before issuing a license.
2951 Independent Foster Home Rules: Evaluated Prior to Issuing an Initial License to a Non-Operating Home Do not complete this form; it is informational only. Licensing staff complete this form to evaluate whether standards are met before issuing a license.
2986 Listing request / PDF Document
Spanish / PDF Document
Submit a request to become a listed home.

Documents

Number Title Purpose
2784 General Residential Operation and Residential Treatment Center Documentation Required at Application / PDF Document This document lists materials that must be submitted with an application, as well as applicable policies and procedures. Informational only.
2785 Child-Placing Agency Documentation Required at Application / PDF Document This document lists materials that must be submitted with an application, as well as applicable policies and procedures. Informational only.
2786 Independent Foster Home Documentation Required at Application / PDF Document This document lists materials that must be submitted with an Independent Foster Home application, as well as applicable policies and procedures. Informational only.

Child Placing Agencies (CPAs)

Forms

Number Title Purpose
2801 CCL - Statement of Foster Parent and Child-Placing Agency Rights and Responsibilities Child Placing Agency staff and foster parents must sign this at the time the home is verified.
2906 CPA Internal Investigation Report / PDF Document Child Placing Agencies (CPAs) voluntarily complete this form to document internal investigations of an allegation or incident.
2934 Medical History Report / PDF Document 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.
2954 Disclosure of Any Family Violence Calls to a Prospective Foster Home Applicants Place of Residence / Spanish Use this form to disclose any incidents of law enforcement responding to a report of family violence at a prospective foster home.
This form must be completed and reviewed during the home study process for each home.
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.
3002 Independent Foster Home Rights / PDF Document Child Care Licensing staff and foster parents must sign this at the time the independent foster home receives an initial license.

Documents

Number Title Purpose
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. Informational only.

Background Checks

Forms

Number Title Purpose
2971 Request for Criminal History check/Central Registry Check
Instructions
Spanish
Spanish Instructions
Applicants and providers without an online account complete this form to request required background checks of staff.
2974 Request for Risk Evaluation Based on Past Criminal History of Central Registry Findings All providers submit this form to the Centralized Background Check Unit (CBCU) 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 provider if one is required.

Fees

Note: Form 2988a has been replaced by forms 3008, 3009, 3010, 3011, and 3012.

Forms

Number Title Purpose
3008
3008s
Listed Family Home Fee Schedule
Spanish
Listed Family Homes complete this form to calculate licensing fees they are required to pay to DFPS. The form is sent with payment.
3009 Registered Child Care Fee Schedule / PDF Document / Spanish Registered Child Care Homes complete this form to calculate licensing fees they are required to pay to DFPS. The form is sent with payment.
3010 Licensed Child Care Fee Schedule / PDF Document Licensed Child Care Centers or Licensed Child Care Homes complete this form to calculate licensing fees they are required to pay to DFPS. The form is sent with payment.
3011 Residential Child Care Licensing Fee Schedule / PDF Document Residential child care providers complete this form to calculate licensing fees they are required to pay to DFPS. The form is sent with payment.
3012 Fee Schedule for Small Employer-Based Child Care Facilities and Temporary Shelter Child Care Facilities / PDF Document Small Employer-Based Child Care and Temporary Child Care Facilities complete this form to calculate licensing fees they are required to pay to DFPS. The form is sent with payment.

Documents

Number Title Purpose
2955
2955s
Licensing Fee Information / PDF Document
Spanish / Spanish PDF
Lists DFPS fees and payment instructions for all providers. Informational only.

Requests for Exemption from Regulation

Forms

Number Title Purpose
2820 Educational Facility - Request for Exemption From Regulation Request exemption from regulation.
2832 Single-skills Program During the School Year - Request for Exemption From Regulation Request exemption from regulation.
2833 Single-Skills Program During The Summer - Request For Exemption From Regulation Request exemption from regulation.
2837 Government Entity - Request For Exemption From Regulation Request exemption from regulation.
2838 Miscellaneous Entities Request For Exemption From Regulation Request exemption from regulation.
2839 Program of Limited Duration Request for Exemption from Regulation Request exemption from regulation.

Medication Authorization

Forms

Number Title Purpose
7238 Authorization For Dispensing Medication / PDF Document Any provider that dispenses medication must document parental consent for giving medication as well as a record of each time a caregiver gives medication to the child. Providers may use this form or their own. This information is required by DFPS and use of this form simplifies record keeping for providers.
7255
7255s
Medication Authorization Form / PDF Document
Spanish / Spanish PDF
Providers must use this form to document authorization from the parent to give medication (including over-the-counter medication) to the child. Providers may also create or use their own form.

Parent or Guardian Information

Documents

Number Title Purpose
2846
2846s
Gang Free Zone Tip Sheet for Providers and Parents / Spanish

This document must be distributed to parents and guardians of children in care at licensed child-care centers. Informational only.

Staff Information

Forms

Number Title Purpose
2551 Licensed/Registered Home: Caregivers, Assistants, Substitutes, and Household Members Information Record - J-800-2551  
2760
2760s
Controlling Person Form / PDF Document
Spanish

Applicants and operations without an online account complete this form to identify who is ultimately responsible for complying with standards and keeping children safe. Mail this form to the local licensing office.
Exception: temporary shelter child-care operations and small employer-based child-care operations are not required to submit controlling-person information.

2819 Governing Body/Administrator or Executive Director Designation - RCCL only All residential child care providers complete this form when the governing body designates an administrator or executive director at a residential operation, or to name a designee of a governing body.
2911 Governing Body/Director Designation / PDF Document

Day care providers complete this form when a director is named at an operation or to name a designee of a governing body.

2947 Center Based Staff Information Record

This form simplifies maintenance of personnel records by centralizing information required by DFPS for child-care centers.
Providers may use their own form.

2982 Personal History Statement / PDF Document

It is highly recommended that all providers use this form to centralize information required by DFPS.
Each director at School-Age and Before- or After-School Programs is required to complete this form as part of the application for a permit or within 10 days of designating a new director.

2985e
2985s
Affidavit for Applicants for Employment With a Licensed Operation or Registered Child-Care Home / Spanish

All applicants for employment complete and submit this form with their application for employment. Each director at School-Age and Before- or After-School Programs is required to complete this form as part of the application for a permit or within 10 days of designating a new director. Keep a copy in each applicant’s personnel file.

7250 Staff Training Record  
7258 Staff Training Records for Residential Child Care Licensing Operations

Providers may use this form or their own to maintain staff training records.

7261 Center Records Evaluation CCL staff and providers may use this form to ensure that required documents are maintained at the operation for review.

Documents to Print for Public Display

Number Title Purpose

2957
2957s

Parent Notification Poster for Center Based Care / PDF Document
Spanish

Display this poster in a visible and publicly accessible place at the child-care center to inform parents of the information they are entitled to view. Informational only, but display is required.

2958
2958s

Keeping Children Safe Poster

Available on the Resources and Links page. Display this poster at any residential or day care facility to inform staff and parents on how to report abuse or neglect. Also provides information on unsafe children's products, Sudden Infant Death Syndrome, Shaken Baby Syndrome, and protecting children from illness and disease. Informational only, but display is required.

7243 Emergency Telephone Numbers / PDF Document Providers are required to have contact information for emergency services. It is recommended that this form be displayed in a public area to ensure the information is readily available. Providers may also use their own form.